Determinants of cesarean delivery in the US: a lifecourse approach.
This study takes a lifecourse approach to understanding the factors contributing to delivery methods in the US by identifying preconception and pregnancy-related determinants of medically indicated and non-medically indicated cesarean section (C-section) deliveries. Data are from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative, population-based survey of women delivering a live baby in 2001 (n = 9,350). Three delivery methods were examined: (1) vaginal delivery (reference); (2) medically indicated C-section; and (3) non-medically indicated C-sections. Using multinomial logistic regression, we examined the role of sociodemographics, health, healthcare, stressful life events, pregnancy complications, and history of C-section on the odds of medically indicated and non-medically indicated C-sections, compared to vaginal delivery. 74.2 % of women had a vaginal delivery, 11.6 % had a non-medically indicated C-section, and 14.2 % had a medically indicated C-section. Multivariable analyses revealed that prior C-section was the strongest predictor of both medically indicated and non-medically indicated C-sections. However, we found salient differences between the risk factors for indicated and non-indicated C-sections. Surgical deliveries continue to occur at a high rate in the US despite evidence that they increase the risk for morbidity and mortality among women and their children. Reducing the number of non-medically indicated C-sections is warranted to lower the short- and long-term risks for deleterious health outcomes for women and their babies across the lifecourse. Healthcare providers should address the risk factors for medically indicated C-sections to optimize low-risk delivery methods and improve the survival, health, and well-being of children and their mothers.
Maternal and Child Health Research, Truven Health Analytics, 7700 Old Georgetown Road, 6th Floor, Bethesda, MD, 20814, USA, whitney.witt@truvenhealth.com.
Whitney P
WP
Witt
Lauren E
LE
Wisk
Erika R
ER
Cheng
Kara
K
Mandell
Debanjana
D
Chatterjee
Fathima
F
Wakeel
Amy L
AL
Godecker
Dakota
D
Zarak
D000293:Adolescent; D000328:Adult; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section / Q000523:psychology* / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D009765:Obesity / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult