Predictors of planned caesarean section births in a sample of Romanian women

Objectives Romania has one of the highest incidences of births by caesarean section (CS) in the European Union (EU). The present study aims to identify the possible predictors of planned caesarean section (PCS) in a convenience sample of Romanian women. Methods This is a secondary analysis of the cross‐sectional data collected as part of the EU‐level Babies Born Better online survey from 1908 Romanian women who gave birth between 2013 and 2018. Univariable and multivariable logistic regression models were performed to identify the potential individual and health system‐level predictors of PCS. Results PCS was reported by 36.7% (n = 657) of the women. In the multivariable regression model, older maternal age (aOR: 1.10, 95% CI: 1.07–1.14) and presence of medical or non‐medical problems during pregnancy (adjusted odds ratio [aOR]: 1.67, 95% CI: 1.31–2.12) were significantly associated with PCS. Conversely, birth at a very high level of competence hospital was inversely associated with PCS (aOR: 0.48, 95% CI: 0.30–0.76). Conclusions Our findings indicate that PCS may be associated with both individual and health system‐level variables. Our results are significant because they could be used to inform decision‐making processes aimed at lowering PCS incidence. Highlights There is an interplay of individual and system‐level determinants of planned caesarean section (PCS). Older age and more years of education were positively associated with PCS. Birth at a very high level of competence hospital lowers the likelihood of PCS. Policies should target individual, clinical and systemic levels to prevent PCS.