Delivery mode by race for breech presentation in the US

Abstract

Objective: To determine if there are differential cesarean delivery rates by race and other socio-demographic factors for women with breech infants.Study Design: We calculated cesarean delivery rates for 186 727 White, African American, Hispanic and Asian women delivering breech singletons with gestational age 26 to 41 weeks born in 1999 and 2000 using data from the National Center for Health Statistics. Multivariable logistic regression was used to determine differences in mode of delivery by race, adjusting for socio-demographic and medical factors.Results: Cesarean rates for breech were >80% in most gestational age groups. In 14 of 18 groups, Whites had higher cesarean delivery rates than African Americans. However, this finding did not persist after risk adjustment. Hispanics were more likely to deliver by cesarean delivery than African Americans and Whites.Conclusion: Breech singleton infants are predominantly born by cesarean delivery. Although African-American women with breech presentation have lower cesarean delivery rates than Whites, this difference is not present after adjusting for socio-demographic and medical factors. Hispanics were more likely to be delivered by cesarean delivery and this difference was amplified after risk adjustment. Asians had slightly lower cesarean rates after risk adjustment, but this varied widely according to Asian subgroup.

Factors Associated with the Recent Increasing Cesarean Delivery Rate at a Japanese Perinatal Center

“…These trends seem to be the same as those previously reported in the USA [1–3, 5, 6] and Japan [7–9]. For example, in a recent observation at other perinatal centers in Japan, Cesarean delivery rate was about 50% in primiparous women aged ≥40 years [8].…”

“…Unfortunately, there are some limitations in this study with the lack of taking into consideration confounders such as education/social economic status/immigrant status/antenatal cares access, all variables known to affect mode of delivery [1–3, 5, 6]. In addition, we believe that “defensive medicine” and litigation as an explicit incentive for performing Cesarean section are unlikely to play a large role.…”

“…Demographic information and the characteristics of labor were extracted from patient charts to examine the potential factors associated with the increasing Cesarean delivery rate. In this study, the factors were selected according to previous studies [1–3, 5, 6]: nulliparity, advanced maternal age (≥35 years), pregnancy-induced hypertension (PIH), preterm delivery, low birth weight (LBW: neonatal birth weight <2,500 g) and macrosomia (neonatal birth weight ≥4,000 g), history of previous Cesarean deliveries, and breech presentation. PIH was defined as blood pressure ≥140/90 mmHg measured on two or more occasions at least six hours apart with the patient at rest.…”

Population trends in cesarean delivery for breech presentation in the United States, 1997-2003

“…We, as well as other investigators have previously used US vital records to perform analyses of breech deliveries using the "breech / malpresentation" code in NCHS datasets. (25)(26)(27)(28) In fact, the latest ACOG committee opinion regarding mode of delivery for breech relies upon this data. (7) In doing these studies, analyses have been based on the assumption that the reporting of breech / malpresentation is primarily indicative of breech presentation or other presentations such as transverse lie in which vaginal delivery may be associated with adverse outcome.…”

Trends in mode of delivery of breech presentation over a 5-year period

“…His observation is very interesting and similar to the observation in the Netherlands, where the cesarean rate for breech increased from 50 to 80% within 2 months after publication of the Term Breech Trial. 1,2 In Sweden, where cesarean rates were higher, the increase was significant, but more modest, from 75 to 86% from 1999 to 2001. 3 We expect that the cesarean rates in the United States were probably less influenced by the recommendations, as they were already at a high level in 1999-2000 (we observed breech cesarean rates of greater than 80% for most gestational age groups).…”