Caesarean section rates are increasing worldwide. It contributes to substantial maternal and perinatal morbidity and mortality. South Asian countries including Bangladesh have recorded substantial increases in caesarean section rates over the past decade. In Bangladesh, the caesarean incidence rate was 2.6 percent in 2001 and 12.2 percent in 2010. So, the incidence rate increased five times over the last decade. This descriptive cross sectional study was conducted at Combined Military Hospital (CMH), Savar, Dhaka during January 2014 to December 2015, aimed to assess the current trend of mode of deliveries of babies. A total of 1253 pregnant women who attended this tertiary level hospital, for their delivery, were enrolled in the study. The study subjects were selected by simple random sampling. A pretested structured questionnaire was used for data collection. The mean age of respondents was 25.81±4.46 years. Most (72%) of them were between 20‐29 years of age. Some thirty nine percent of the respondents completed secondary level of education. The study showed that among 1253 respondents, 70.3% underwent CS and 29.7 % had normal vaginal delivery. Most common indication for caesarean section was previous CS (42.4%) that contributed an increase in total caesarean birth. Lowest incidence was antepartum haemorrhage (0.9%). Prolonged labour and cervical dystocia, hypertensive disorder, malpresentation were also contributing factors for caesarean section. So, previous caesarean birth was the most important factor in making decision about the way of delivery. Based on the study findings, to decrease the rate of caesarean section, careful monitoring of the foetus at all levels of health care facilities for critical decisions are suggested.

Caesarean delivery, also known as caesarean section (CS), is a form of childbirth in which a surgical incision is made through a mother′s abdomen and uterus to deliver the baby.¹ It is one of the most common surgical procedures among women. The introduction of caesarean section surgery was associated with an improvement in maternal and perinatal health outcomes.² Access to comprehensive emergency obstetric care, including CS, is key to preventing the estimated 287 000 maternal and 2.9 million neonatal deaths worldwide every year.^3,4 Although debate continues about how to quantify the need for life-saving CS, a World Health Organization (WHO) report suggested that the optimal population range for CS rate is between 5% and 15%, This endures as a reference.^5,6 However, WHO has stated that no empirical evidence exists for an ideal caesarean rate, but "what matters most is that all women who need CS actually receive them″.⁷

Caesarean section rates are increasing worldwide, albeit unequally: a recent analysis of Demographic and Health Survey (DHS) data in 26 South Asian and sub-Saharan African countries found that rates were highest among the 'urban rich' in all countries, and lowest among the 'rural poor' in 18 countries.⁸ In all countries, fewer than 5% of mothers in the poorest wealth quintile delivered by caesarean.⁹ In areas with very high mortality rates, such as Africa, inadequate availability of CS contributes to substantial maternal and perinatal morbidity and mortality.¹⁰ Conversely, in many developed countries, concerns exist about high rates of CS, since increasing rates of this procedure show little evidence of further improvement in perinatal outcomes.¹¹ South Asian countries have recorded substantial increases in CS rates over the past decade. In Bangladesh, rates rose from 2% (2000) to 17% (2011); in India, from 3% (1992) to 11% (2006); and in Nepal, from 1% (2000) to 5% (2011).^12-14

Caesarean section carries its own risks for maternal and infant morbidity and for subsequent pregnancies.¹⁵ The procedure is associated with significant increases in maternal and infant morbidity and mortality, particularly in low-income countries. Increases in maternal morbidity are particularly prevalent after an emergency CS or a CS performed during the second stage of labor.¹⁶ AWHO survey of 373 facilities across 24 countries found that unnecessary caesareans were associated with an increased risk of maternal mortality and serious outcomes for mothers and newborn infants, compared with spontaneous vaginal delivery.¹⁷ Many factors have contributed to the increasing rates of CS including medical and non-medical factors. Medical factors include increases in maternal age and body mass index and changes in obstetric practices and technologies. Non-medical factors include CS requested by the mother, the inappropriate organization of maternity care and physician- induced demand for CS.^18,19 There is significant variation in the CS rate in terms of socioeconomic status.²⁰ A systematic review and meta-analysis of observation studies revealed that the preference for a CS in women is greater than 15%. Recent evidence also shows that the demand for a CS among young, educated women residing in urban areas has increased.²¹ According to the limited available research, the CS in Bangladesh is considerably higher than the recommended upper limit of 10%.²²

The proportion of women giving birth by CS in private rather than public facilities also varied widely between settings. In Bangladesh, only 21% of women delivered in a health facility, around half of them in the private/charitable sector, but 73% of private facility births were by caesarean section. In 2011, three in five facility births were delivered by CS which reflects the historicaltrend that in 2001‐2003, nearly half of deliveries in private facilities in Bangladesh were performed by CS.²³ Data from rural area, socioeconomically disadvantaged communities in three districts of Bangladesh, Bogra, Maulvibazaar and Faridpur, suggestthat high CSrates in private facilities arenot merely an issue for wealthy urban mothers. Although some study from Bangladesh suggests that mothers may have a preference for caesarean delivery because of fear of labour pain or a desire to select an auspicious date for the birth, other studies also highlight women′s fears of CS and their distrust of health providers who claim high costs for the procedure. The lack of association between caesareans and complications in pregnancy or delivery, high financial incentives given to providers for performing CSand the requirement for junior doctors to ‘practise′ their surgical skills, suggest that CSis being used over andabove clinical need. A possible explanation for the significant interactive associations between maternal education and caesarean delivery in public and privatefacilities in Bangladesh is that well-educated women maybe delivering in more expensive or highly rated institutions, which may in turn be more likely to perform CSforfinancial reasons and if they act astraining centers for junior doctors.²⁴

Recent ecological analyses also highlighted strong associations between caesarean delivery and increased neonatal mortality in countries with low and medium caesarean section rates.²⁵ Unnecessary caesareans lead to considerable costs for families and health systems: an estimated 6.2 million unnecessary procedures were performed in 2008, costing approximately US$2.32 billion.²⁶ The literature from other settings indicates that increases in caesarean sections are shaped by supply and demand pressures: providers often have financial incentives to intervene surgically, and women of higher socioeconomic status are also more likely to opt for caesareans.^27,28 Some women consider C- section is more advantageous than natural birth. They think that a C-section is a modern procedure to have a baby, involving the use of technology.²⁹

Considering the information, the present study was conducted in a combined military hospital at Savar, Bangladesh situated adjacent to the capital city Dhaka to assess the current trend of the caesarean section and its indication,over the two successive years.