Occupation and risk of cesarean section: study based on the perinatal survey of Baden-Württemberg, Germany

The aim of this study was to assess the current influence of educational attainment and occupation on maternal obstetrical risk associated with cesarean section under the conditions of an industrialized country and provision of universal coverage.

The perinatal survey data 1998-2001 of the German state of Baden-Württemberg were studied comparing method of delivery for the different occupational categories raised in the survey and the influence of antenatal care utilization. For statistical analysis chi square test, Fisher's exact test and chi square test for trends were used. Relative risks describe the risk for the exposed.

Cesarean section rate increased for all groups over the studied four years period. High rates of surgical deliveries were found for the categories "high salaried position" and "unskilled workers". Housewives, the largest group of pregnant women in Baden-Württemberg, delivered significantly less often by cesarean section (75% vaginal deliveries) than women of all other groups (66% vaginal deliveries on the average). In case of low utilization of antenatal care (<5 checks) risk of cesarean section and rate of complications (as blood loss >1,000 ml, hysterectomy) associated with cesarean section are significantly higher.

Differences in an individual woman's risk of having a cesarean section is, besides many other factors, associated with occupation. Antenatal care promotion should target the collective of unskilled workers, at special risk for insufficient use of prenatal care and high rate of cesarean delivery.