Trends in Mode of Delivery in Public and Private Sector Hospitals in the Negombo Municipal Council Area (2019 – 2023)

Abstract

Background: One of the most important decisions in maternity care is the mode of delivery. While normal vaginal delivery is the natural and preferred route for uncomplicated childbirth, lower-segment cesarean section is a lifesaving intervention when medically indicated. However, the increasing use of cesarean section beyond clinically justified levels has become a major public health concern worldwide. Aims: The present study describes trends in normal vaginal delivery and lower-segment cesarean section in public and private sector hospitals within the Negombo Municipal Council area. Study Design: Retrospective hospital-based descriptive study. Place and Duration of Study: District General Hospital Negombo, Nawaloka Hospital Negombo, and Ave Maria Hospital Negombo, Sri Lanka, using annual institutional delivery data from 2019 to 2023. Methodology: Annual institutional delivery data from one public hospital and two private hospitals within the Negombo Municipal Council area were reviewed to describe the pattern of normal vaginal delivery and lower-segment cesarean section from 2019 to 2023. Only aggregate institutional data were analyzed. Frequencies and percentages were used to summarize the annual distribution of delivery mode in the public and private sectors. A Cochran-Armitage test for trend was applied to assess changes in the proportion of lower-segment cesarean sections over time. Results: In the public sector, lower-segment cesarean section increased from 40% (n = 1639) in 2019 to 46% (n = 1394) in 2023, while normal vaginal delivery decreased from 60% (n = 2418) to 54% (n = 1650). The upward trend in lower-segment cesarean section in the public sector was statistically significant (P < .001). In the private sector, lower-segment cesarean section increased from 74% (n = 345) in 2019 to 84% (n = 679) in 2023, while normal vaginal delivery decreased from 26% (n = 122) to 16% (n = 130). The private-sector upward trend in lower-segment cesarean section was also significant (P = .003). The private sector consistently showed a higher percentage of lower-segment cesarean sections than the public sector throughout the study period. Conclusion: Lower-segment cesarean section showed an overall rising trend in both sectors, with a markedly higher rate in private hospitals. These findings highlight the need for regular institutional audit, closer review of cesarean indications, and stronger measures to promote appropriate and evidence-based obstetric care.