title: A comparison of trends in cesarean delivery in Paraguay between 1995 and 2008.
abstract: OBJECTIVE
  To identify maternal factors associated with the rise in the cesarean delivery rate in Paraguay.
  
  
  METHODS
  Retrospective analysis of the 1995 and the 2008 National Survey on Demographic and Sexual and Reproductive Health data using multivariable logistic regression.
  
  
  RESULTS
  In 2008, 1094 (37.3%) deliveries were cesarean compared with 781 (19.3%) in 1995. Home births had decreased by 72.9%, accounting for 33.3% of the change in the proportion of cesarean deliveries. Private facilities were associated with an increased odds ratio of cesarean delivery of 2.60 (95% confidence interval [CI], 2.02-3.34) and 4.89 (95% CI, 3.67-6.51) in 1995 and 2008, respectively, and accounted for 32.8% of the increase in cesarean deliveries between 1995 and 2008. Cesarean delivery was also associated with a prior cesarean, insurance status, and maternal higher educational and economic status.
  
  
  CONCLUSIONS
  Between 1995 and 2008 the cesarean delivery rate in Paraguay almost doubled. More than one-third of deliveries were cesarean. Shifts toward facility- (particularly private) based deliveries and repeat cesarean for women with a previous cesarean influenced this increase. Practice guidelines, regulation, and oversight of facilities, along with education and information for pregnant women, are needed to curb unnecessary and potentially harmful surgical delivery interventions.
authors: Travel Medicine Northwest, Bellingham, USA.
authors: Jiasong
authors: J
authors: Yuen
authors: Northwest Center for Public Health Practice, Department of Health Services, University of Washington, Seattle, USA.
authors: Ian
authors: I
authors: Painter
authors: School of Public Health, University of Washington, Seattle, USA.
authors: Linta
authors: L
authors: Abraham
authors: Centro Paraguayo de Estudios de Población, Asunción, Paraguay.
authors: Mercedes
authors: M
authors: Melian
authors: Department of Pediatrics, University of Washington, Seattle, USA; Department of Global Health and Health Services, University of Washington, Seattle, USA. Electronic address: ddenno@u.washington.edu.
authors: Donna M
authors: DM
authors: Denno
mesh_terms: D000293:Adolescent; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006306:Health Surveys; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010239:Paraguay / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies
keywords: Cesarean; Epidemiology; Health surveys; Infant mortality; Maternal mortality; Paraguay; Pregnancy complications; Reproductive health