Neonatal outcomes associated with planned vaginal versus planned primary cesarean delivery

Geller, Elizabeth J.; Wu, Jennifer M.; Jannelli, Mary L.; Nguyen, Thao V.; Visco, Anthony G.

doi:10.1038/jp.2009.150

Cited by 46 publications

(31 citation statements)

References 18 publications

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“…Similar results are reported in the international literature, where midwife-led care is associated with fewer obstetric interventions than other models of care [14]. Although it is clear that adequate access to obstetric interventions such as emergency caesarean delivery can save the life of both the mother and infant [15], [16], high rates of operative delivery, particularly rates above 15%, may result in poorer maternal and infant outcomes for the current or subsequent births [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30]. With the rising caesarean section rates during the last few decades in the developed world, adverse outcomes following birth are gaining greater attention [31], [32], [33], [34], [35].…”

Section: Discussionsupporting

confidence: 71%

“…However, it appears clear from other studies that increases in maternal or foetal risk indicating the need for operative delivery are not a major factor [39], [40]. Due to the increased risk of injury and morbidity in the mother and infant following high rates of operative deliveries [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], it seems clear that although the LHC policy may have been successful in achieving the government’s aim of relieving pressure on public hospitals [7], it may not have been beneficial for quality obstetric care in Australia.…”

Section: Discussionmentioning

confidence: 99%

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Increase in Caesarean Deliveries after the Australian Private Health Insurance Incentive Policy Reforms

et al. 2012

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Background The Australian Private Health Insurance Incentive (PHII) policy reforms implemented in 1997–2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA). Methods and Findings All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the PHII introduction were estimated and compared with expected rates had the reforms not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately for public and private patients, by mode of delivery, and by length of stay in hospital following birth. The PHII policy introduction was associated with a 20% (−21.4 to −19.3) decrease in public birth rates, a 51% (45.1 to 56.4) increase in private birth rates, a 5% (−5.3 to −5.1) and 8% (−8.9 to −7.9) decrease in unassisted and assisted vaginal deliveries respectively, a 5% (−5.3 to −5.1) increase in caesarean sections with labour and 10% (8.0 to 11.7) increase in caesarean sections without labour. Similarly, birth rates where the infant stayed 0–3 days in hospital following birth decreased by 20% (−21.5 to −18.5), but rates of births with >3 days in hospital increased by 15% (12.2 to 17.1). Conclusions Following the PHII policy implementation in Australia, births in privately insured patients, caesarean deliveries and births with longer infant hospital stays increased. The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Increase in Caesarean Deliveries after the Australian Private Health Insurance Incentive Policy Reforms

et al. 2012

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“…[3][4][5][6] For example, studies have reported that children born by cesarean delivery may have increased rates of respiratory illness in their first year of life 5,7,8 and beyond, 9,10 and relationships have also been described with diabetes 11 and child overweight and obesity. 12,13 Notwithstanding these potential adverse associations, children born by cesarean delivery are usually healthy, and it is important to recognize that many factors influence child health other than mode of birth.…”

Section: What This Study Addsmentioning

confidence: 99%

Childhood Health and Developmental Outcomes After Cesarean Birth in an Australian Cohort

Robson¹,

Vally

Abdel-Latif

et al. 2015

Pediatrics

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BACKGROUND AND OBJECTIVES: Concerns have been raised about associations between cesarean delivery and childhood obesity and asthma. However, published studies have not examined the long-term neurodevelopmental outcomes or fully addressed confounding influences. We used data from the LSAC (Longitudinal Study of Australian Children) to explore the relationship between cesarean delivery and physical and socio-emotional outcomes from 0 to 7 years, taking into account confounding factors.

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“…Apgar scores at 5 minutes have reported to be better in healthy infants born by elective caesarean than in other infants [22] and our results indicated that privately insured women were almost twice as likely as publicly insured women to deliver by pre-labour caesarean section following a preterm birth. However, adjusting for mode of delivery did not change our results and it is therefore more likely that the higher risk of low Apgar score in publicly insured women in public hospitals is either due to residual confounding in our data or practise differences between public and private hospitals in Western Australia.…”

Section: Discussionmentioning

confidence: 52%

Neonatal outcomes after preterm birth by mothers’ health insurance status at birth: a retrospective cohort study

Einarsdóttir

Haggar

Langridge

et al. 2013

BMC Health Serv Res

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BackgroundPublicly insured women usually have a different demographic background to privately insured women, which is related to poor neonatal outcomes after birth. Given the difference in nature and risk of preterm versus term births, it would be important to compare adverse neonatal outcomes after preterm birth between these groups of women after eliminating the demographic differences between the groups.MethodsThe study population included 3085 publicly insured and 3380 privately insured, singleton, preterm deliveries (32–36 weeks gestation) from Western Australia during 1998–2008. From the study population, 1016 publicly insured women were matched with 1016 privately insured women according to the propensity score of maternal demographic characteristics and pre-existing medical conditions. Neonatal outcomes were compared in the propensity score matched cohorts using conditional log-binomial regression, adjusted for antenatal risk factors. Outcomes included Apgar scores less than 7 at five minutes after birth, time until establishment of unassisted breathing (>1 minute), neonatal resuscitation (endotracheal intubation or external cardiac massage) and admission to a neonatal special care unit.ResultsCompared with infants of privately insured women, infants of publicly insured women were more likely to receive a low Apgar score (ARR = 2.63, 95% CI = 1.06-6.52) and take longer to establish unassisted breathing (ARR = 1.61, 95% CI = 1.25-2.07), yet, they were less likely to be admitted to a special care unit (ARR = 0.84, 95% CI = 0.80-0.87). No significant differences were evident in neonatal resuscitation between the groups (ARR = 1.20, 95% CI = 0.54-2.67).ConclusionsThe underlying reasons for the lower rate of special care admissions in infants of publicly insured women compared with privately insured women despite the higher rate of low Apgar scores is yet to be determined. Future research is warranted in order to clarify the meaning of our findings for future obstetric care and whether more equitable use of paediatric services should be recommended.

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Neonatal outcomes associated with planned vaginal versus planned primary cesarean delivery

Cited by 46 publications

References 18 publications

Increase in Caesarean Deliveries after the Australian Private Health Insurance Incentive Policy Reforms

Increase in Caesarean Deliveries after the Australian Private Health Insurance Incentive Policy Reforms

Childhood Health and Developmental Outcomes After Cesarean Birth in an Australian Cohort

Neonatal outcomes after preterm birth by mothers’ health insurance status at birth: a retrospective cohort study

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