Assessing the Rise and Variability of Caesarean Deliveries in Sialkot: A Descriptive Analysis of Public Hospital Data (2017–2021)

http://amresearchreview.com/index.php/Journal/about Volume 3, Issue 8 (2025) Online ISSN Print ISSN . . http://amresearchreview.com/index.php/Journal/about Page 667 Assessing the Rise and Variability of Caesarean Deliveries in Sialkot: A Descriptive Analysis of Public Hospital Data (2017–2021) Tehmeena Mukhtar M.Phil. Sociology-Fatima Jinnah Women University, Rawalpindi Email: [email protected] Asima Manzoom MS Local DevelopmentUniversity of Padua, Italy Faiza Nosheen M.Phil. Pak Studies, Quaid-e-Azam University, Islamabad Muhammad Danial Moin Ph.D. Scholar-Sociology-Arid Agriculture, Rawalpindi Cesarean section based on medical reasons is a generally carried out procedure around the globe. It has become a public concern globally. The rate of C-Sections in Pakistan increased alarmingly from 17% (PDHS, 2017-18) to 26% (PDHS, 2019-20). It has also been observed that C-sections are more commonly performed by the private sector as compared to the public, speculating that there is over-medicalization of childbirth. The current study was an endeavor to explore why C-section as a mode of childbirth is being practiced and what are the associated factors behind it in public hospitals of Sialkot. This study was analytical and descriptive in the 5 years of recorded data of two public hospitals (Allama Iqbal memorial teaching Sardar begum teaching hospital) Sialkot were assessed. Content analysis was done to assess the prevalence of cesarean section. The data showed that the prevalence of cesarean section has increased over the years in the year 2017 to 2020 and gradually declined in 2021. The socio-demographic and medical reasons were found behind the extensive use of cesarean sections. Keywords: Cesarean Section; Public Hospitals; Over-Medicalization; Medical Factors. INTRODUCTION Background of the study Caesarean section is commonly performed surgery on medical reasons to save the child and mother from complications. C-section is considered a lifesaving surgery within the world, but in the recent years it is performed for non-medical reasons as http://amresearchreview.com/index.php/Journal/about Volume 3, Issue 8 (2025) Online ISSN Print ISSN . . http://amresearchreview.com/index.php/Journal/about Page 668 well. World health organization (WHO) suggested the rate of C-section should be within 10% to 15%. (WHO, 2001). The optimal rate of C-section should not be strived but in the previous years the rate of C-section has been exceeding its optimal limits (WHO,2015). It has been observed that the rate of C-section is usually higher in high -income settings rather than low-income settings. In the recent decades the increasing rates of C-section has induce the concern of people to find out the factors influences the steady increase in C-section and other shortand long-term risks associated with C-section (Manyeh, et al., 2018). The rate of C-section has been increased from its optimal rates in south Asian countries. Pakistan is also one of those countries in which the Cesarean section rates has been increased in last two decades (Amjad, et al., 2020). The increasing trends of C-section has serious complications upon the health of female and also it is increasing the burden of hospitals and the health system of Pakistan (Wagner, 2000). C-section rates has been increased in between 1990-2017 from 6.7% to 19.1% in all over the world (Global Health Research Center 2021). There is an increase of 4.2% in developing countries and 12.7% in developed countries. The countries with highest rates of C-section are Latin America and Caribbean (sage W 2021).whilst the rate in low income countries is also increasing steadily. The recent study in south Asian countries depicts that the rate has been increased from 3.2% in 1990 to 20% in 2018 (Aisha.A, 2020). The increasing rate of C-section has many institutional and socio demographic reasons. In the recent decades the C-section deliveries for medical and none medical reasons has been performed widely without taking into account the short and long term risks (Abass, F.2018). C-section is considered the lifesaving surgery but the unnecessary use of this surgery may have long term effects on maternal health. Researches highlights that there is an increase of 2 to 4 times in maternal mortality who underwent C-section (Amjad, 2020). Additionally, the research also shows a low level of immunity system in the children who born with C-section and the mother experienced C-section may also experience physiological and psychological issues after the surgery (Solheim,2011). Moreover, the C-section is mostly performed by private sector hospitals in developing countries (Aisha, Amjad, 2020). Pakistan is also among those countries in which Csection is most commonly performed by private sector hospitals for none medical reasons( Pakistan Demographic and health survey PDHS 2017-2018). The above discussion shows that there is an increase in C-section in both developing and underdeveloped countries. Asian countries including Pakistan is striving from optimal rates of C-section (Mumtaz, 2017; Amjad 2020), and private sector is most contributing factor of increase in C-section for none medical reasons (PDHS 2018, Mumtaz, 2017, Aisha 2020). Patterns and practices of C-sections have been significantly changed in recent years. The researcher aims to investigate why the C-section has been commonly performed and has a shift from optimal to alarming. It is widely reported ted that the private sector is performing more C-sections as compared to the Public in Pakistan (as per PDHS, the 2017-18) speculating nonmedical reasons and over-medicalization of childbirth. Research question What is the current prevalence of Cesarean sections in public http://amresearchreview.com/index.php/Journal/about Volume 3, Issue 8 (2025) Online ISSN Print ISSN . . http://amresearchreview.com/index.php/Journal/about Page 669 hospitals of Sialkot RESEARCH METHODOLOGY To explore the current issue researcher used quantitative method. The nature of this study is analytical descriptive under the lenses of constructivism in which researcher collected the descriptive statistical evidences to assess the prevalence of cesarean section cases in public hospitals (Allama Iqbal memorial teaching hospital, Sardar begum teaching hospital) Sialkot, which provided the details majorly related to the medical factors leading towards C-Section. Secondary data of 5 years from twice public hospitals of Sialkot has been collected to access the prevalence of C-section. Data analysis technique Data of the study has been analyzed by using content analysis, the graphical presentation of the data and the analysis has been done to understand the prevalence of cesarean section in twice hospitals of Sialkot. Ethical concern In this research the researcher ensured the professional competence whereby the information obtained has been presented in an unbiased manner. An ethical approval was obtained from the hospitals. RESULTS AND ANALYSIS Cesarean Sections are very common mode of birth now a day 2017: Monthly data was collected from the recorded history of Sardar Begum Memorial Teaching Hospital, Sialkotand Allama Iqbal Memorial Teaching Hospital, Sialkot to assess the prevalence and reasons associated with cesarean section, which is enlisted in tables 4.1 and 4.2 along with their percentages. Sardar begum memorial teaching hospital (2017): The prevalence of cesarean section in Sardar begum memorial teaching in the year 2017 has been discussed. It was observed that total 5101 patient admission were done for deliveries in the hospital in year 2017 in which 53% were vaginal deliveries and 47% were delivered through cesarean section. The major reason associated with cesarean section has been observed mainly the age of mother, hypertension and repeated cesarean are the most common were found in the history of 2017. Whole data along with percentage is mentioned in table 4.1 and graphically illustrated in figure 4.1. Figure 4. 1: Sardar Begum Memorial Teaching Hospital, Sialkot for the year of 2020 In Sardar begum memorial teaching hospital it was observed 5948 deliveries were done in which 58.68% were vaginal and 41.32% were done via C section. Data is mentioned in table 4.7and graphically illustrated through bar graph. The prevalence of cesarean section has decreased in the year of 2020 due to the outburst of Covid-19 in Allama Iqbal memorial teaching hospital Sialkot because there are lack of infrastructure and resources to treat the Covid-19 effected patients. All the wards were http://amresearchreview.com/index.php/Journal/about Volume 3, Issue 8 (2025) Online ISSN Print ISSN . . http://amresearchreview.com/index.php/Journal/about Page 670 used to adjust and treat the patients with the virus of Covid-19. Allama Iqbal memorial teaching hospital (2020): Table 4. 1: Data table of Allama Iqbal memorial teaching hospital Sialkot for the year of 2020 In Allama Iqbal memorial teaching hospital it was observed 5136 deliveries were done in which 1938 37.73% were vaginal and 62.27% were done via C section. Data is mentioned in table 4.8 and graphically illustrated through 3D cylindrical graphs.it has been observed that in the starting months of the year 2021 the C-section has been observed with the gradual increase where the situation after Covid-19 were stabled. Comparison (2017-2021): Comparison of whole data in between 2017 to 2021 of both hospitals (Sardar begum memorial teaching hospital and Allama Iqbal memorial teaching hospital Hospital: Table 4. 2: Data table of Sardar begum teaching hospital Sialkot for the year of 2017-2021 Sr # Year Sardar begum memorial teaching hospital Allama Iqbal memorial teaching hospital Hospital Vaginal %age Csection %age Vaginal %age Csection %age 1 2017 2400 20.70 2701 16.61 2232 19.96 3340 18.45 2 2018 2573 22.20 3658 22.48 2703 24.17 4194 23.17 3 2019 2383 20.56 3716 22.84 2150 19.22 3558 19.64 4 2020 2458 21.20 3490 21.45 1938 17.32 3198 17.66 5 2021 1775 15.31 2703 16.61 2162 19.32 3817 21.08 6 Total 11589 16268 11185 18107 Collective 27857 29292 Graphical presentation of data of Sardar Begum Memorial Teaching Hospital, Sialkot http://amresearchreview.com/index.php/Journal/about Volume 3, Issue 8 (2025) Online ISSN Print ISSN . . http://amresearchreview.com/index.php/Journal/about Page 671 for the year of 2017-2021 Figure 4. 2: Allama Iqbal Memorial Teaching Hospital, Sialkot for the year of 2017-2021 Graphical presentation of data of Allama Iqbal Memorial Teaching Hospital, Sialkot for the year of 2017-2021 Figure 4. 3: Allama Iqbal Memorial Teaching Hospital, Sialkot for the year of 2017-2021 While having a glance on collective data of both selected hospitals which are Allama Iqbal memorial teaching hospital and Sardar Begum Memorial Teaching Hospital, it 0 500 1000 1500 2000 2500 3000 3500 4000 4500 1 2 3 4 5 Sardar begum memorial teaching hospital 2017-2021 Normal C-section 0 500 1000 1500 2000 2500 3000 3500 4000 4500 1 2 3 4 5 Normal C-section http://amresearchreview.com/index.php/Journal/about Volume 3, Issue 8 (2025) Online ISSN Print ISSN . . http://amresearchreview.com/index.php/Journal/about Page 672 is obvious to us that there are fluctuations in vaginal and cesarean section deliveries. In 2017, there were 20.70% vaginal deliveries and 16.61% cesarean section deliveries at Sardar Begum Teaching Hospital. While at Allama Iqbal Memorial Teaching Hospital, there were 19.96% vaginal deliveries and 18.45% cesarean section studies in 2017. In 2018, there were 22.20% vaginal deliveries and 22.48 % cesarean section deliveries at Sardar Begum Teaching Hospital. While at Allama Iqbal Memorial Teaching Hospital, there were 24.17% vaginal deliveries and 23.17% cesarean section studies in 2018. In 2019, there are 20.56% vaginal deliveries and 22.84% cesarean section deliveries at Sardar begum teaching hospital. While at Allama Iqbal memorial teaching hospital there are 19.22% vaginal deliveries and 19.64% are cesarean section studies in 2019. In 2020, there are 21.20% vaginal deliveries and 21.45% cesarean section deliveries at Sardar begum teaching hospital. While at Allama Iqbal memorial teaching hospital there are 17.32% vaginal deliveries and 17.66% are cesarean section studies in 2020. In 2021, there are 15.31% vaginal deliveries and 16.61% cesarean section deliveries at Sardar begum teaching hospital. While at Allama Iqbal memorial teaching hospital there are 19.32% vaginal deliveries and 21.08% are cesarean section studies in 2021. When it was compared the whole data of five years between both hospital with respect to vaginal and cesarean section deliveries, it was clearly seen that there is small to moderate fluctuation in rationale data of deliveries. Cesarean section cases are randomly increasing now days because of complicated medical reasons. As a whole in 2018 there was increase in number of admissions in deliveries was observed and majority of pregnancies were deal with cesarean section. It has been observed that the rates of CS has been increased in the year of 2019 to 2020 and gradually decreased in the year of 2021. The outburst of Covid-19 is a significant factor in decreasing the rates of cesarean in the year of 2020-2021 on the other hand due to the lack of resources and lack of health care access in Allama Iqbal teaching females has to experienced their Cesarean from Sardar begum teaching hospital. The emergency cases were handled in Allama Iqbal memorial teaching hospital during the period of Covid-19. The increasing rates of cesarean section depicts the medical reasons were the leading factor of cesarean section while there are some socio-demographic issues are also found with the association of Cesarean section. The main leading factor was the repeated cesarean section, and the less gap between pregnancies were found in the recorded history of patients from Sardar begum teaching hospital Sialkot. It has been observed that the females from rural area are more likely to visit the Sardar begum memorial teaching hospital and Allama Iqbal teaching hospital Sialkot and the females from rural areas are more likely to experience the C-section as compare to the females from urban areas. Discussion It is evident that C-section is common in public hospitals. In majority of the cases the medical reasons are common. it is evident that C-section has been mentioned as important to save the life of mother or children or both. The work of (Elnakib et al., 2019) is relevant in this regard. The authors conducted extensive research in Egypt and concluded that medical reasons are evident in case of majority of C-sections. The common medical reason indicated included non-reassuring fetal status or fetal distress http://amresearchreview.com/index.php/Journal/about Volume 3, Issue 8 (2025) Online ISSN Print ISSN . . http://amresearchreview.com/index.php/Journal/about Page 673 without a documented fetal heart rate tracing or monitoring were commonly recorded. The current study also indicates that fetal distress and non-reassuring fetal status commonly led to the C-section WHO defined data in 1985, where it was mentioned that the ideal rate for C-section is between 10 to 15 % worldwide. According to World Health Organization data, in Pakistan, the c-section rate was 3.2% during the 1990s, while it increased to 19.86% in recent years. The concept of vaginal deliveries is getting rare nowadays. However, in a survey by the WHO, it is said that there is still 49% cases that are delivered via vaginal delivery in Pakistan. rate may get high in the upcoming years. The current study was done at Sialkot city of Punjab Pakistan. Public Hospitals of Sialkot( AIMTH, SBMTH) were selected and interviews are done from the females who has experienced CS at least once. Rationale data was taken from hospitals by checking their records as well. From 2017 to 2021 data was selected and it was shown that in Sardar begum memorial teaching hospital 27857 deliveries were done in which 10579 were vaginal deliveries and 16268 were done via c section. In Allama Iqbal memorial teaching hospital hospital 29292 deliveries were done in which 11185 was vaginal delivery while 18107 were done via c section. Suggestions WHO suggested that the extensive use of cesarean section cannot be justified in any population, therefore, the common trends of cesarean section are a serious concern and the health institutions should revisit this matter. 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