How Much Do Mothers Know? Evaluating Awareness of Medical Justifications for First Cesarean Deliveries: A Cross-sectional Study

Background: The rising rate of cesarean deliveries has generated concern about whether all procedures are medically justified. Limited data exist on how well first-time mothers understand the indications for their cesarean section in Iraq. Objective: To assess maternal knowledge of the medical reasons for the first cesarean delivery and its relationship with sociodemographic, obstetric, and neonatal characteristics. Methods: A cross-sectional study was conducted from October to December 2023 among 158 Iraqi women who underwent their first cesarean delivery. Data were collected using a structured, self-administered online questionnaire that assessed demographic, obstetric, and knowledge-related factors. Results: Less than half of the mothers (48.1%) demonstrated good knowledge of the reason for their cesarean section, whereas 23.4% showed poor awareness. Knowledge level was significantly associated with residency (p=0.024), history of vaginal birth (p=0.001), place of delivery (p=0.001), type of cesarean section (p=0.001), and hypertension during pregnancy (p=0.025). Mothers from rural areas, those delivering in public hospitals, and those undergoing emergency procedures had the highest proportions of poor knowledge. Poor awareness was also linked with adverse neonatal outcomes, including low birth weight (p=0.036), preterm birth (p=0.003), and neonatal distress (p=0.001). Conclusions: A considerable proportion of first-time Iraqi mothers lack adequate understanding of the medical indications for their cesarean delivery. Educational interventions and improved patient–provider communication, especially in rural areas and public hospitals, are essential to promote informed decision-making and better maternal–neonatal outcomes.