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The purpose of this study was to examine adverse outcomes associated with cesarean deliveries and to assess potential confounding factors.

A hospital-based cross-sectional study was conducted from September 1−30, 2019 using mixed methods of data collection. Multistage sampling was used to draw the eligible study participants. The sample size was calculated using the single population proportion formula. A systematic random sampling technique was used to draw the sample size. 180 original medical records were excluded because of having missed information, leaving 1,618 women as the study population. We used the questionnaire adapted from the Ethiopian Demographic and Health Survey to collect quantitative data and analyzed using SPSS version 22, while thematic analysis for qualitative measures was used to generate themes regarding associated perspectives of participants from a community.

More than 383 women delivered by cesarean section. 20% of the mothers with the mean age at birth of 26.1 ± 4.8 experienced adverse outcomes. Adjusted odds ratio (AOR) was used to measure the association of determinants and was 2.95 (95% CI 1.19–7.29) for nonuse of antenatal care, 3.18 (95% CI 1.43–6.94) for nonuse of prophylaxis, 4.28 (95% CI 1.58−11.61) for history of medical illness and 7.09 (95% CI 1.19−45.59) for use of substandard operation set up compared with their counterparts.

Strengths of the study include the finding of the study are reliably reported in mixed study methods examining hospital-based institutional and personal risk factors and exploring the whole community's perspectives. However, the important limitations of the study indicate that the study poses a number of challenges related to studying design, therefore there was not sufficient evidence of causality to draw conclusions from the findings. In addition, the study was conducted at a single hospital so that it is not convenient to generalize the findings of the study for setting different in social and economic status.

Based on the findings, attention has been drawn to healthcare personnel to provide training and consultation services for pregnant women and for health care administration to ensure standard set up for operation.