Determinants of Cesarean Delivery in the US: A Lifecourse Approach

Abstract

Objectives This study takes a lifecourse approach to understanding the factors contributing to delivery methods in the United States by identifying preconception and pregnancy-related determinants of medically indicated and non-medically indicated Cesarean section (C-section). Methods 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-section. 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-section, compared to vaginal delivery. Results 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 find salient differences between the risk factors for indicated and non-indicated C-sections. Conclusions Surgical deliveries continue to occur at a high rate in the United States 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.

Examining the link between women's exposure to stressful life events prior to conception and infant and toddler health: the role of birth weight

“…For example, using data from the ECLS-B, Witt et al found that exposure to at least one PSLE increased the odds of VLBW by 38%. [7] In separate studies, the authors also found associations between PSLEs and the likelihoods of PTB among teenage mothers[15] and of delivering via medically-indicated Cesarean section. [15] Similar associations have also been noted in Danish populations.…”

“…[7] In separate studies, the authors also found associations between PSLEs and the likelihoods of PTB among teenage mothers[15] and of delivering via medically-indicated Cesarean section. [15] Similar associations have also been noted in Danish populations. [21] Fewer studies have examined the prospective effect of preconception stress with outcomes after the perinatal period, although some European-based evidence ties preconception stress to the risk of infant mortality, [13] childhood ADHD, [12] overweight status in adolescence, [12] and adult affective disorder in men.…”

“…[7, 15] Briefly, we derived the date of conception using birth certificate information on the length of gestation and the infant’s date of birth. We coded women as having experienced a PSLE if they reported that one or more of the following events occurred prior to conception: (1) death of their mother; (2) death of their father; (3) death of a previous live born child; (4) divorce; (5) separation from partner; (6) death of a spouse; or (7) problems with infertility (Appendix 3).…”

Taxonomy for complexity theory in the context of maternity care

“…The flaws in this approach are evident, for example, in the growing controversy over the unintended consequences of routine screening for breast cancer for women (Autier et al, 2011;Roukema, 2013), and in the increasing concern about the longer term (and even epigenetic) potential for adverse effects associated with the continuing rise in the use of caesarean section for an ever wider list of indications in maternity care (MacDorman et al, 2008;Dahlen et al, 2013;Witt et al, 2014). Both seem logical, as a means of preventing adverse events.…”

“…Both seem logical, as a means of preventing adverse events. In the event, both have been shown to have unintended consequences in practice, both for individuals (iatrogenic mortality and physical, psychological emotional morbidity need for further treatment, and decreased quality of life), and for society, in terms of diversion of health resources, and economic consequences ( Van der Steeg et al, 2011;Moynihan et al, 2013;Witt et al, 2014).…”