Publication date: Aug 01, 2025

Although cesarean sections (CS) are necessary surgical procedures when correctly indicated, they also carry maternal and neonatal risks. Growing evidence suggests that medical and, especially, non-medical factors, are driving the global increase in CS rates. This study aims to analyze the association between pregnancy- and birth-related factors and the likelihood of cesarean delivery in Spain. This cross-sectional study analyzed 4,902,675 births registered in the Spanish Statistical Birth Bulletin (2010-2021). Inclusion criteria comprised all live births with a registered type of delivery. The primary outcome was delivery type (vaginal or cesarean section). Independent covariates included maternal age, nationality, municipality size, parity, number of fetuses, education level, newborn sex, gestational age, COVID-19 period, day of the week, year of birth and region of birth. Bivariate and multivariate logistic regression analyses were conducted for the calculation of OR and 95% CI. The overall CS rate was 26,6 % with a declining trend. Risk factors included maternal age >40 years (OR: 3. 89; 95 %CI 3. 87-3. 91), preterm births at 28-32 weeks (OR: 5. 23; 95 %CI 5. 21-5. 25), male newborn (OR: 1. 09; 95 %CI 1. 09-1. 10), and deliveries during the COVID-19 pandemic (OR: 1. 01; 95 %CI 0. 99-1. 03). Weekend deliveries (Saturday OR: 0. 67; 95 %CI 0. 66-0. 68 and Sunday OR: 0. 61; 95 %CI 0. 61-0. 62), non-Spanish mother’s nationality (OR: 0. 97; 95 %CI 0. 96-0. 97) and size of mother’s municipality >100. 000 inhabitants (OR: 0. 94; 95 %CI 0. 94-0. 95) were identified as protective factors. Cesarean sections do not depend exclusively on obstetric and gynecological factors, but also on sociodemographic variables and others related to the time of delivery.

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