Epidemiology of operación cesárea in Mexican border communities

BACKGROUND: Cesarean sections (CS) in Mexico have high complication rates and tax the health care system. Although data from one Mexican border community indicate that CS may be common, the frequency of CS in Mexican border communities overall is unknown and risk factors are unexplored. METHODS: Using data from Mexico's 2006 National Health and Nutrition Survey (ENSANUT) of households from 80 border counties in border states (Baja California, Sonora, Chihuahua, Coahuila, Nuevo Leon, Tamaulipas), we selected parous women (ages ³20) with ³1 live birth after 1999 (N=511). We computed weighted proportions of CS for the most recent birth and 7 socio-demographic and clinical covariates and used logistic regression to calculate crude and adjusted ORs. RESULTS: Forty-three percent of women reported a CS at their last birth. In bivariate analyses, risk of CS was associated with age ³25 years (OR=2.0; 95%CI=1.1-3.6), private versus public birthing facilities (OR=1.6, 95%CI=1.03-2.4), and high-risk pregnancy (diabetes, high blood pressure and/or obesity) (OR=1.4, 95%CI=0.95-2.1). No relationship was found between CS and prenatal care, education, parity or a previous ³4kg. live birth. Multivariate modeling confirmed the associations for older age (OR=2.4, 95%CI=1.4-4.2) and high-risk pregnancy (OR=1.5, 95%CI=1.0-2.4); other estimates were unchanged. CONCLUSIONS: Results are comparable to the previously reported high CS rate in one border community. Although risk factors are consistent with other literature, explaining the high CS rate in this population should be a research priority.