Cesarean Delivery Rates and Provider Perspectives in a Rural Indigenous Community in Guatemala

Background Cesarean delivery is an life-saving procedure that has reduced rates of maternal and neonatal mortality globally. However, in many regions, including Latin America, cesarean delivery rates have risen abruptly to levels that are higher than what are recommended or expected solely based on obstetric indications. This study aimed to investigate the rates of cesarean delivery and primary indications at Hospitalito Atitlán, a non-profit hospital serving a rural, indigenous Maya population in Guatemala, and to assess provider attitudes and beliefs about mode of delivery and knowledge of the indications and risks of cesarean delivery. Methods This is a mixed methods descriptive study that included retrospective data collection and surveys. Demographic and health information about the pregnancy and delivery was collected from all patients who delivered at Hospitalito Atitlán between 11/2023 and 10/2024. Qualitative data was collected using REDCap survey administered to all physicians, nurses, and staff at Hospitalito Atitlán from November 18–29, 2024. Results Of the 98 deliveries over the 11 month study period, 83 (85%) were by cesarean delivery. The two most common listed indications for cesarean delivery were previous cesarean delivery and non-reassuring fetal heart tracing (each 27.7%). The third most common indication was oligohydramnios (18.1%). The 17 survey participants consisted of general practitioners, nurses, and other staff. No OBGYNs participated in the survey. The majority of participants wanted to avoid unnecessary cesarean deliveries (82.4%) and were interested in learning about the indications for (82%) and complications of (75.5%) cesarean delivery. Conclusions Cesarean delivery rates at Hospitalito Atitlán exceed the national average, suggesting that factors other than medical indications may be contributing. Staff expressed interest in reducing unnecessary cesarean deliveries, highlight opportunities for targeted education and interventions.