Abstract
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.
Similar content being viewed by others
Notes
We estimated the total number of C-sections attributable to PSLEs by differencing the average marginal effect of PSLEs on C-sections under the assumption that all women with any PSLE became unexposed (note that this estimate amounts to 11 % of all C-sections among women exposed to any PSLEs, or 2.8 % of all C-sections). We then multiplied this number by the difference in allowed paid amount between vaginal and C-section delivery cited by Truven Health Analytics [6] ($3,691 per delivery) to obtain the total C-section-related expenditures associated with these deliveries.
References
MacDorman, M. F., Menacker, F., & Declercq, E. (2008). Cesarean birth in the United States: Epidemiology, trends, and outcomes. Clinics in Perinatology, 35(2), 293–307.
Hamilton, B., Martin, J., & Ventura, S. (2011). Births: Preliminary data for 2010. National Vital Statistics Report, 60(2), 3.
Boutsikou, T., & Malamitsi-Puchner, A. (2011). Caesarean section: Impact on mother and child. Acta Paediatrica, 100(12), 1518–1522.
Pai, M. (2000). Unnecessary medical interventions: Caesarean sections as a case study. Economic and Political Weekly, 35(31), 2755–2761.
Soet, J. E., Brack, G. A., & DiIorio, C. (2003). Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth (Berkeley, Calif.), 30(1), 36–46.
The cost of having a baby in the United States. Ann Arbor, MI: Truven Health Analytics; (2013). http://transform.childbirthconnection.org/wp-content/uploads/2013/01/Cost-of-Having-a-Baby1.pdf.
Declercq, E., Barger, M., Cabral, H. J., et al. (2007). Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstetrics and Gynecology, 109(3), 669–677.
Liu, T. C., Chen, C. S., & Lin, H. C. (2008). Does elective caesarean section increase utilization of postpartum maternal medical care? Medical Care, 46(4), 440–443.
Halfon, N., & Hochstein, M. (2002). Life course health development: An integrated framework for developing health, policy, and research. Milbank Quarterly, 80(3), 433–479.
Early Childhood Longitudinal Study, Birth Cohort, nine-month data collection. U.S. Department of Education, National Center for Education Statistics; (2001). Washington, DC.
Kalish, R. B., McCullough, L., Gupta, M., et al. (2004). Intrapartum elective cesarean delivery: A previously unrecognized clinical entity. Obstetrics and Gynecology, 103(6), 1137–1141.
Johnson, E. M, & Rehavi, M. M. (2013). Physicians treating physicians: Information and incentives in childbirth. Cambridge, MA: National Bureau of Economic Research. http://www.nber.org/papers/w19242.
Chu, S., Kim, S., Schmid, C., et al. (2007). Maternal obesity and risk of cesarean delivery: A meta-analysis. Obesity Reviews, 8(5), 385–394.
Bansil, P., Kuklina, E. V., Meikle, S. F., et al. (2010). Maternal and fetal outcomes among women with depression. Journal of Women’s Health, 19(2), 329–334.
Khashan, A., McNamee, R., Abel, K., et al. (2009). Rates of preterm birth following antenatal maternal exposure to severe life events: A population-based cohort study. Human Reproduction, 24(2), 429–437.
Khashan, A. S., McNamee, R., Abel, K. M., et al. (2008). Reduced infant birthweight consequent upon maternal exposure to severe life events. Psychosomatic Medicine, 70(6), 688–694.
Class, Q. A., Khashan, A. S., Lichtenstein, P., et al. (2013). Maternal stress and infant mortality: The importance of the preconception period. Psychological Science, 24(7), 1309–1316.
Witt, W. P., Cheng, E. R., Wisk, L. E., et al. (2014). Maternal stressful life events prior to conception and the impact on infant birth weight in the United States. AJPH, 104(S1), S81–S89.
Witt, W. P., Cheng, E. R., Wisk, L. E., et al. (2014). Preterm birth in the United States: The impact of stressful life events prior to conception and maternal age. AJPH, 104(S1), S73–S80.
Cohen, S., & Williamson, G. M. (1987). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The social psychology of health: Claremont symposium on applied social psychology (pp. 31–49). Newbury Park, CA: Sage.
Dunkel-Schetter, C. (2011). Psychological science on pregnancy: Stress processes, biopsychosocial models, and emerging research issues. Annual Review of Psychology, 62, 531–558.
McEwen, B. S. (2006). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33–44.
Wadhwa, P. D., Culhane, J. F., Rauh, V., et al. (2001). Stress, infection and preterm birth: A biobehavioural perspective. Paediatric and Perinatal Epidemiology, 15(S2), 17–29.
Seng, J. S., Oakley, D. J., Sampselle, C. M., et al. (2001). Posttraumatic stress disorder and pregnancy complications. Obstetrics and Gynecology, 97(1), 17–22.
Da Costa, D., Larouche, J., Dritsa, M., et al. (2000). Psychosocial correlates of prepartum and postpartum depressed mood. Journal of Affective Disorders, 59(1), 31–40.
Kramer, M. R., Hogue, C. J., Dunlop, A. L., et al. (2011). Preconceptional stress and racial disparities in preterm birth: An overview. Acta Obstetricia et Gynecologica Scandinavica, 90(12), 1307–1316.
The American Congress of Obstetricians and Gynecologists (ACOG) committee opinion no. 559. (2013). Cesarean delivery on maternal request. Obstetrics and Gynecology, 121(4), 904–907.
Grobman, W. A., Gersnoviez, R., Landon, M. B., et al. (2007). Pregnancy outcomes for women with placenta previa in relation to the number of prior cesarean deliveries. Obstetrics and Gynecology, 110(6), 1249–1255.
Silver, R. M., Landon, M. B., Rouse, D. J., et al. (2006). Maternal morbidity associated with multiple repeat cesarean deliveries. Obstetrics and Gynecology, 107(6), 1226–1232.
American College of Obstetricians and Gynecologists. (2014). Safe prevention of the primary cesarean delivery. Obstetrics and Gynecology, 123, 693–711.
Cunningham, F. G., Bangdiwala, S., Brown, S., et al. (2010). Vaginal birth after cesarean: New insights. National Institutes of Health Consensus Development Conference. pp. 1279–1295.
Leeman, L. M., Beagle, M., Espey, E., et al. (2013). Diminishing availability of trial of labor after cesarean delivery in New Mexico hospitals. Obstetrics and Gynecology, 122 (2, Part 1), 242–247.
Roberts, R. G., Deutchman, M., King, V. J., et al. (2007). Changing policies on vaginal birth after cesarean: Impact on access. Birth (Berkeley, Calif.), 34(4), 316–322.
Northam, S., & Knapp, T. R. (2006). The reliability and validity of birth certificates. Journal of Obstetric, Gynecologic and Neonatal Nursing, 35(1), 3–12.
Wakeel, F., Wisk, L., Gee, R., et al. (2013). The balance between stress and personal capital during pregnancy and the relationship with adverse obstetric outcomes: Findings from the 2007 Los Angeles Mommy and Baby (LAMB) study. Archives of Women’s Mental Health, 16(6), 435–451.
Acknowledgments
This project was made possible by a Health Resources and Services Administrative (HRSA) (W.P.W., L.E.W., and D.C.: R40MC23625; PI: W.P. Witt) grant. Additional funding for this research was provided by grants from the Agency for Healthcare Research and Quality (K.M. and L.E.W.: T32 HS00083; PI: M. Smith), the Health Disparities Research Scholars Program (F.W.: T32 HD049302; PI: G. Sarto), the 2012–2013 Herman I. Shapiro Distinguished Graduate Fellowship (L.E.W.), and the Science and Medicine Graduate Research Scholars Fellowship from the University of Wisconsin in the College of Agriculture and Life Sciences and the School of Medicine and Public Health (ERC).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Witt, W.P., Wisk, L.E., Cheng, E.R. et al. Determinants of Cesarean Delivery in the US: A Lifecourse Approach. Matern Child Health J 19, 84–93 (2015). https://doi.org/10.1007/s10995-014-1498-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-014-1498-8