Factors Influencing the Choice and Deviation from Planned Spontaneous Vaginal Delivery among Mothers Admitted to Kahawatta Base Hospital Ratnapura, Sri Lanka

Abstract

Background: Spontaneous vaginal delivery (SVD) is preferred for its health benefits, but maternal choices and medical factors influence its prevalence. Rising cesarean rates highlight the need to understand deviations from planned SVD. Objective: To investigate the associated factors influencing the choice of SVD and deviation from planned SVD among mothers admitted for childbirth at Kahawatta Base Hospital, Ratnapura, Sri Lanka Methods: A descriptive cross-sectional study, was conducted among 120 postnatal mothers, recruited through convenience sampling. Data was collected through an interviewer-administered questionnaire, developed based on previous literature. Data was analysed using SPSS version 25.0, and Chi-square test was used to assess associations. Results: The majority of the mothers were aged 26-35 years (74.2%, n=89) (mean±SD; 31.42±4.65), married (90.8%, n=109), and had education up to the Ordinary Level (72.5%, n=87). The Most resided in rural areas (65.0%, n=78) and were unemployed (84.2%, n=101). Most deliveries occurred at >37 weeks gestation (59.2%, n=71), with newborns weighing between 2.5- 3.5 kg. Of 120 mothers, 35.8% (n=43) of deliveries deviated from planned SVD to LSCS (30.8%, n=37) and instrumental delivery (5.0%, n=6). The Chi-square test results showed significant associations between ethnicity (p=0.018) and occupation (p=0.012) with the choice of mode of delivery. Moreover, obstetric history of antepartum hemorrhage and post-partum hemorrhage (p=0.022) and presentation of liquor (p=0.007) were significantly associated with the deviation from planned SVDs. Conclusion: Ethnicity and occupation significantly influence the mode of delivery, highlighting the need for culturally sensitive and employment-focused maternal healthcare strategies. It is recommended to strengthen antenatal care by identifying high-risk mothers early and providing targeted counseling on delivery options. Enhancing maternal education and improving access to timely obstetric interventions, especially in rural areas, can reduce unplanned deviations and promote safer birthing outcomes.