title: Indications for Cesarean Sections in Rural Nepal.
abstract: OBJECTIVE
  Globally, cesarean section (CS) rate is close to 26 %. Nepal has a reported CS rate of 5 %, with huge differences in rural (3.5 %) and urban (15 %) areas. The aim of the study was to determine the rate and indications for CS in a remote hospital in a rural area of Nepal.
  
  
  METHODS
  A one-year cross-sectional prospective study from August 2014 to August 2015 was performed at Okhaldhunga Community Hospital (OCH). Semi-structured interviews of all women undergoing CS (91) were done, partly with the assistance of a local translator. A maternal waiting home is connected to the hospital.
  
  
  RESULTS
  Out of the 864 births in the hospital, 91 CS were performed giving a CS rate of 9.5 %. The most frequent indications were: prolonged labor in 24 CS (26.4 %), abnormal fetal lie in 23 CS (25.3 %) and fetal distress in 18 CS (19.8 %). Three-quarters of CS were performed as an emergency. Almost half of the women stayed in the maternal waiting home prior to birth.
  
  
  CONCLUSIONS
  The CS rate at OCH was relatively low, within WHO's recommendation, with types of indication similar to other countries. There were no signs of CS overuse. Maternal request was not the sole indication in any CS.
authors.affiliation: Faculty of Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway.
authors.forename: Live Johanne
authors.initials: LJ
authors.lastname: Samdal
authors.affiliation: Faculty of Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway.
authors.forename: Kristina Reberg
authors.initials: KR
authors.lastname: Steinsvik
authors.affiliation: Okhaldhunga Community Hospital, Okhaldhunga, 56100 Nepal.
authors.forename: Prakash
authors.initials: P
authors.lastname: Pun
authors.affiliation: Okhaldhunga Community Hospital, Okhaldhunga, 56100 Nepal.
authors.forename: Phanindra
authors.initials: P
authors.lastname: Dani
authors.affiliation: Faculty of Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway.
authors.forename: Borghild
authors.initials: B
authors.lastname: Roald
authors.affiliation: Faculty of Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway.
authors.forename: Babill
authors.initials: B
authors.lastname: Stray-Pedersen
authors.affiliation: Okhaldhunga Community Hospital, Okhaldhunga, 56100 Nepal.
authors.forename: Erik
authors.initials: E
authors.lastname: Bøhler
keywords: Cesarean section; Global trends; Indications; Maternal health; Nepal; Rural area