Geospatial variation in caesarean delivery

Vanderlaan, Jennifer; Edwards, Johnathan A.; Dunlop, Anne L.

doi:10.1002/nop2.433

Cited by 6 publications

(11 citation statements)

References 31 publications

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“…The results of the full model agree with prior studies that both increased midwife density and independent midwifery practice are associated with a reduction of primary cesarean birth. [1][2][3]5,6 This study adds to the literature by demonstrating an interaction between independent midwifery practice and midwife density on the association with pregnancy outcomes. Currently, only 2 studies have examined the effect of state adoption of independent midwifery practice on primary cesarean, and neither study controlled for the density of midwives in the main analysis.…”

Section: Discussionmentioning

confidence: 61%

Midwifery Workforce Density Moderates the Association Between Independent Practice and Pregnancy Outcomes

Vanderlaan

2023

J Midwife Womens Health

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IntroductionStudies comparing pregnancy outcomes before and after state transition to independent midwifery practice have found little change in primary cesarean birth and preterm birth rates. One reason may be the failure to control for midwife density. The objective was to test if the local midwife density moderates the association between state independent midwifery practice and pregnancy outcomes.MethodsBirth records were abstracted from the State Inpatient Databases for 6 states. The Area Health Resource File provided county variables. Midwife density was operationalized as no midwives, low midwife density (<4.5 per 1000 births), and high midwife density (≥4.5 midwives per 1000 births). Multivariate logistic regression models compared primary cesarean birth and preterm birth, controlling for maternal and county characteristics. Moderation was tested by including an interaction term (independent practice × density) to the regression models. The magnitude of association for the interaction was measured by stratifying the models.ResultsThe study included 875,156 women; most (79.7%) resided in a county with low midwife density. Restricted midwifery practice was associated with increased odds of both primary cesarean birth and preterm birth. The interaction term was significant for both preterm birth and primary cesarean, indicating moderation. The largest magnitude of difference was the increased odds of preterm birth in counties with a high midwife density and restricted practice (odds ratio, 3.50; 95% CI, 2.43‐5.06) compared with those with high midwife density and independent practice.DiscussionMidwife density moderates the association between independent midwifery practice and primary cesarean birth and preterm birth. Moderation may explain why prior studies found small or no changes in outcomes when states adopted independent practice. Moderation models can improve testing for associations with independent practice. Both midwife independent practice and increasing midwifery workforce size can be strategies to improve state pregnancy outcomes.

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Section: Discussionmentioning

confidence: 61%

Midwifery Workforce Density Moderates the Association Between Independent Practice and Pregnancy Outcomes

Vanderlaan

2023

J Midwife Womens Health

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“…According to the World Health Organization (WHO), CS should cover 10% to 15% of all deliveries at most [8,9]. However, the worldwide CS rate increased from 6.7% in 1990 to 21% in 2021, with 14.3% growth [8], and spatial variations in CS distribution are observed in different geographical areas [10,11].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The fourth group of studies used geographical and spatial analysis to explain and interpret CS rates [11,19]. For instance, Vanderlaan et al [11] in Georgia identified counties with high-rate CS clusters had significantly lower access to midwives. Furthermore, more deliveries were paid by Medicaid in these counties, and a higher proportion of births for women belonging to racial/ ethnic minority groups were more likely to be rural.…”

Section: Introductionmentioning

confidence: 99%

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Geospatial analysis of cesarean section in Iran (2016–2020): exploring clustered patterns and measuring spatial interactions of available health services

Mohammadi

Pishgar

Salari

et al. 2022

BMC Pregnancy Childbirth

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Background The lives of babies and mothers are at risk due to the uneven distribution of healthcare facilities required for emergency cesarean sections (CS). However, CS without medical indications might cause complications for mothers and babies, which is a global health problem. Identifying spatiotemporal variations of CS rates in each geographical area could provide helpful information to understand the status of using CS services. Methods This cross-sectional study explored spatiotemporal patterns of CS in northeast Iran from 2016 to 2020. Space–time scan statistics and spatial interaction analysis were conducted using geographical information systems to visualize and explore patterns of CS services. Results The temporal analysis identified 2017 and 2018 as the statistically significant high clustered times in terms of CS rate. Five purely spatial clusters were identified that were distributed heterogeneously in the study region and included 14 counties. The spatiotemporal analysis identified four clusters that included 13 counties as high-rate areas in different periods. According to spatial interaction analysis, there was a solid spatial concentration of hospital facilities in the political center of the study area. Moreover, a high degree of inequity was observed in spatial accessibility to CS hospitals in the study area. Conclusions CS Spatiotemporal clusters in the study area reveal that CS use in different counties among women of childbearing age is significantly different in terms of location and time. This difference might be studied in future research to identify any overutilization of CS or lack of appropriate CS in clustered counties, as both put women at risk. Hospital capacity and distance from population centers to hospitals might play an essential role in CS rate variations and spatial interactions among people and CS facilities. As a result, some healthcare strategies, e.g., building new hospitals and empowering the existing local hospitals to perform CS in areas out of service, might be developed to decline spatial inequity.

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“…We used birth and C-section data from the March of Dimes and the National Center for Health Statistics during the years 2015-2019 across 3105 US counties [3]. Moran's I statistic was calculated to categorize individual counties as either Not Significant or as one of 4 statistically significant (p < 0.05) cluster classifications: High-High (H-H), High-Low (H-L), Low-High (L-H), Low-Low (L-L) [4]. In this attribution system, the first term designates the relative value of a given county compared to the national average; the second attribute reflects the relative value of neighboring counties compared to the national average.…”

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confidence: 99%

Prematurity and low birth weight: geospatial analysis and recent trends

Peterman

Kaptur

Lewis

et al. 2022

matern health, neonatol and perinatol

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Prematurity and low birth weight are of concern in neonatal health. In this work, geospatial analysis was performed to identify the existence of statistically significant clusters of prematurity and low birth weight using Moran’s I. Data was obtained from March of Dimes and the National Center for Health Statistics for the years 2015 to 2019. Analysis demonstrated the presence of hotspot (High-High) and coldspot (Low-Low) geographic clusters of these variables in regions across the United States. Additionally, factorial ANOVA was performed, and revealed the significance of demographic variables of interest. Given the strong relationship between these two variables, regions that are hotspots for one variable, but not the other, are of particular interest for further study.

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Geospatial variation in caesarean delivery

Cited by 6 publications

References 31 publications

Midwifery Workforce Density Moderates the Association Between Independent Practice and Pregnancy Outcomes

Midwifery Workforce Density Moderates the Association Between Independent Practice and Pregnancy Outcomes

Geospatial analysis of cesarean section in Iran (2016–2020): exploring clustered patterns and measuring spatial interactions of available health services

Prematurity and low birth weight: geospatial analysis and recent trends

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