Normal Birth Action Plan associated with reduced cesarean rates in Turkish cohort

BackgroundCesarean section (CS) rates have risen globally to unprecedented levels, becoming a major public health concern. Türkiye has one of the highest CS rates among OECD countries, reaching approximately 57%, far above World Health Organization recommendations. In response, the Ministry of Health introduced the Normal Birth Action Plan (NBAP) in October 2024 to promote vaginal birth (VB) and reduce medically unnecessary CS. However, the real-world impact of NBAP in private hospitals—where maternal preference, fear of childbirth, institutional dynamics, and medico-legal concerns strongly influence mode of birth—remains unclear.ObjectiveTo evaluate the early effects of NBAP on mode of birth distribution in a private hospital and to examine CS indications, maternal preference, and the role of NBAP-related counseling.MethodsThis retrospective single-centre study included 2,226 births between October 2023 and October 2025, comparing 1-year pre-NBAP and post-NBAP periods. Maternal age, mode of birth, CS type, CS indication, and NBAP counseling status were analyzed. Categorical variables were compared using chi-square tests, with p < 0.05 considered statistically significant.ResultsMean maternal age was 27.37 ± 5.04 years (range: 18–43). CS rates decreased from 89% in the pre-NBAP period (1215/1365) to 81% in the post-NBAP period (698/861), representing a reduction in CS rate from 89% to 81%, alongside a decrease in absolute CS numbers, which should be interpreted in the context of reduced total births. VB increased from 11% to 19% (an 8%-point increase). CS attributed to maternal request or fear of VB declined from 26.1% to 17%. Mode of birth and CS indications differed significantly between periods (p < 0.001). Similar trends were observed across age groups (18–30 vs. ≥31 years). Monthly analyses showed a gradual increase in VB following NBAP implementation. Total births decreased by approximately 37% during the post-NBAP period, suggesting additional contextual or demographic influences.ConclusionIn this private hospital cohort, the post-NBAP period was temporally associated with a reduction in cesarean births and an increase in vaginal births, along with a decrease in CS attributed to maternal request or fear of VB. However, given the retrospective design and concurrent changes in birth volume, causality cannot be inferred. Multicentre studies with longer follow-up are required to clarify these associations.