Determinants and outcomes of caesarean section in low-risk primigravida women at a tertiary hospital in Northern Tanzania

Background Caesarean section (CS) rates are increasing globally, including among women without clear obstetric indications. Primigravida women are a key population for understanding factors contributing to primary caesarean delivery, as the initial mode of birth influences outcomes in subsequent pregnancies. In Tanzania, evidence on predictors and outcomes of CS among low-risk primigravida women, particularly in tertiary referral hospitals, remains limited. This study aimed to determine the prevalence, predictors, and maternal and neonatal outcomes of caesarean section among low-risk primigravida women delivering at Kilimanjaro Christian Medical Centre (KCMC). Methods A hospital-based prospective cohort study was conducted at KCMC from October 2024 to March 2025. A total of 180 low-risk primigravida women with singleton, term pregnancies in cephalic presentation were enrolled. Data were collected using structured electronic questionnaires and medical record reviews. Poisson regression with robust standard errors was used to estimate crude and adjusted risk ratios (RR and aRR) with 95% confidence intervals for predictors of caesarean section. Maternal and neonatal outcomes were compared by mode of delivery. Results The prevalence of caesarean section was 38.9% (70/180). After adjustment, induction of labour (aRR = 1.9; 95% CI: 1.3–2.7) and absence of a birth companion during labour (aRR = 3.1; 95% CI: 2.1–4.4) were independently associated with an increased risk of caesarean section. Maternal age, body mass index, number of antenatal care visits, gestational age at delivery, and estimated fetal weight were not independently associated with caesarean delivery.While overall adverse maternal outcomes were low, the most severe cases (hysterectomy, ICU admission, and death) occurred only after vaginal delivery. Neonatal outcomes differed; CS deliveries accounted for all NICU admissions, most neonatal deaths (75%), and a slight majority (55.6%) of low APGAR scores (≤ 7). Conclusions Caesarean section was common among low-risk primigravida women at this tertiary referral hospital. Intrapartum factors, particularly induction of labour and lack of continuous birth companionship, were significant predictors of caesarean delivery. Strengthening labour management practices and promoting birth companionship may help reduce unnecessary caesarean sections and improve maternal and neonatal outcomes.