Surge in C-section deliveries during the COVID-19 pandemic: insights from a cross-sectional study in Gujarat, India.

Background: The COVID-19 pandemic wreaked havoc and devastated economic, social and healthcare systems worldwide, particularly in resource-constrained countries. Maternal and child health outcomes deteriorated amidst the pandemic due to the pandemic's multifaceted effects, including the viral infection itself, stringent containment policies and evolving guidelines for antenatal and postnatal care services. While numerous studies have documented the increasing prevalence of C-section deliveries, there remains a dearth of evidence on the factors contributing to this trend during the pandemic. This study aimed to document the trend and contributing factors in the mode of delivery during the COVID-19 pandemic in Gujarat, India. Method: A cross-sectional survey was carried out on 611 women who delivered during the pandemic (from March 2020 to February 2022); data were collected on the sociodemographic profile, reproductive history, mode of delivery and factors contributing to the overall C-section delivery using the WHO-recommended Robson's 10-group classification system (TGCS) tool. Result: Study findings documented a C-section rate of 45.7%, which is significantly higher than the WHO threshold and the latest national average. The primary contributors to the overall C-section rate, as identified by Robson's TGCS groups, were group 5 (multiparous with previous caesarean section (CS), single, cephalic, ≥37 weeks) followed by group 2 (nulliparous, single cephalic, ≥37 weeks, induced labour or CS before labour) and group 1 (nulliparous, single cephalic, ≥37 weeks, spontaneous labour). Among COVID-19-infected mothers, the C-section rate was even higher, with preterm birth emerging as a third major contributing factor. Conclusions: These findings underscore the urgent need to address the increasing trend of C-section deliveries, conduct comprehensive analyses targeting these groups, evaluate existing management protocols and conduct further research into indications of C-section and outcomes in the local context. These steps are crucial in our collective efforts to reduce the C-section delivery rate and design tailored strategies.