Explainable tabular deep learning models for antenatal cesarean delivery prediction in multiparous women

Abstract

Background/Objectives Globalincreases in cesarean section (C-section) rates, often exceeding medical necessity, highlight the need for accurate antenatal prediction to support evidence-based birth planning. Reliable prediction of delivery mode is essential for reducing maternal and neonatal morbidity, improving clinical decision-making, and optimizing resource allocation. This study analyzes a publicly available dataset of 460 multiparous women, including 18 obstetric and antenatal variables, published by Yimer and Mekonnen. Methods Deep learning architectures were systematically evaluated for predicting delivery mode in multiparous pregnancies. Classical Multilayer Perceptrons (MLPs) served as baseline models, while modern tabular deep learning methods were assessed as advanced alternatives. Preprocessing included multiple imputation, outlier removal, and class balancing via SMOTE. Feature selection was performed using a hybrid Boruta-clinical expert strategy. Hyperparameters were tuned through Random Search. To improve interpretability, an explainability pipeline integrating SHAP and LIME was incorporated. Results Optimized MLPs produced modest performance gains, but dedicated tabular models demonstrated clear superiority. TabNet achieved the highest performance, with an ROC-AUC of 0.79 and a PR-AUC of 0.74, attributed to its attention and masking mechanisms and robust handling of minority classes. TabPFN and CBAM-MLP yielded stable and balanced results, whereas FT-Transformer showed competitive yet comparatively moderate accuracy. Conclusions The findings demonstrate that modern tabular deep learning approaches, particularly TabNet, surpass baseline MLP architectures in terms of accuracy, explainability, and clinical applicability for predicting C-section in multiparous women. This study presents the first comprehensive and explainable comparison of tabular deep learning models tailored to multiparous pregnancies, combining hybrid Boruta-expert feature selection with SHAP and LIME interpretability. TabNet emerges as the most promising candidate for integration into clinical decision support systems, contributing substantially to Al-driven strategies for addressing rising global C-section rates.