Shifting Patterns in Cesarean Delivery Scheduling and Timing in Oregon before and after a Statewide Hard Stop Policy

Muoto, Ifeoma; Darney, Blair G.; Lau, Bernard; Cheng, Yvonne W.; Tomlinson, Mark; Neilson, Duncan R.; Friedman, Steven A.; Rogovoy, Joanne; Caughey, Aaron B.; Snowden, Jonathan M.

doi:10.1111/1475-6773.12797

Cited by 7 publications

(4 citation statements)

References 35 publications

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“…The comparative interrupted time series approach combines the strengths of several quasi‐experimental approach (ie, ITS and difference‐in‐differences), by controlling for secular time trends before and after policy implementation, and comparing the policy group to a control group that is not exposed to a similar policy 39 . Although the policy was implemented at a single time (October 1, 2009), prior research on this policy and others has demonstrated gradual changes in childbirth care after implementation of policy changes, 10,19,30,31 so we targeted the postpolicy quarterly time‐trend as our effect of interest, rather than the postpolicy level difference.…”

Section: Methodsmentioning

confidence: 99%

“…Our hypothesis was based on the findings that a greater share of cesareans among black women are performed without medical indication 9,11 and are amenable to prevention. Changes in childbirth care have been documented to occur gradually rather than immediately in response to changes in policy and care recommendations, 10,30,31 so we hypothesized that reductions would accrue gradually in the postpolicy period, resulting in a potential trend change, rather than an immediate drop after the policy. Results from this analysis may help further explain how policies and social context (including structural racism) may translate into racial inequities, a topic of particular relevance in maternal health 13,32 .…”

Section: Introductionmentioning

confidence: 99%

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Cesarean birth and maternal morbidity among Black women and White women after implementation of a blended payment policy

Snowden

Osmundson

Kaufman

et al. 2020

Health Services Research

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The rate of cesarean birth in the United States is widely acknowledged to be too high. 1,2 Cesarean birth is medically necessary in some clinical scenarios and can be a life-saving procedure, but it also carries increased risks when used without a medical indication and/or at an early gestational age. These include risks for infants (eg, respiratory distress syndrome, admission to the neonatal intensive care unit 3,4) and birthing people (eg, infection, hysterectomy, venous thromboembolism 5-7). There are racial disparities in the rate

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cesarean birth and maternal morbidity among Black women and White women after implementation of a blended payment policy

Snowden

Osmundson

Kaufman

et al. 2020

Health Services Research

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“…(42) The study from Snowden et al resulted in another publication by Muoto et al and is an additional analysis. (37,46) We used the rst publication by Snowden et al and added outcome data from the subsequent publication. All studies included women with elective CS which was safe for mother and neonate to be postponed from 37 + 0-38 + 6 WG to ≥ 39+(0-6) WG.…”

Section: Study Characteristicsmentioning

confidence: 99%

A Systematic Review on the Effectiveness of Implementation Strategies to Postpone Elective Caesarean Sections to ≥39+(0-6) Week of Gestation.

Prediger

Heu-Parvaresch

Bühn

et al. 2020

Preprint

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Background: Caesarean sections often have no urgent indication and are electively planned. Research showed that elective caesarean section should not be performed until 39+(0-6) week of gestation to ensure best neonatal and maternal health if there are no contraindications. This was recommended by various guidelines published in the last two decades. With this systematic review we are looking for implementation strategies trying to implement these recommendations into clinical practice. Methods: We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL and CINAHL in November 2019. We included studies that assessed implementation strategies aiming to postpone elective caesarean section to ≥39+(0-6) week of gestation. There were no restrictions regarding the type of implementation strategy or reasons for elective caesarean section. Our primary outcome was the rate of elective caesarean sections before 39+(0-6) week of gestation. We did a narrative analysis of the results.Results: We included 9 studies, of which were 2 interrupted time series and 7 before-after studies, covering 205.954 elective caesarean births. All studies included various types of implementation strategies. All implementation strategies showed success in decreasing the rate of elective caesarean sections performed <39+(0-6) week of gestation. Risk difference differed from -7 (95% CI -8; -7) to -45 (95% CI -51; -31). 3 studies reported rate of neonatal intensive care unit admission and showed little reduction.Conclusion: This systematic review shows that all presented implementation strategies to reduce elective caesarean section before 39+(0-6) weeks of gestation are effective. Reduction rates differ widely and it remains unclear which strategy is most successful. Strategies used locally in one hospital seem a little more effective. For planning an implementation strategy to reduce elective caesarean section before 39+(0-6) weeks of gestation it is necessary to consider specific barriers and facilitators and take all obstetric personal into account.Systematic review registration: Registered in PROSPERO (CRD42017078231)

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“…Increasing awareness of the potential adverse consequences of LPET delivery, together with rising rates of LPET births during the late 20th and early 21st centuries [52][53][54][55], led to the development of various policies and initiatives aimed at minimising planned deliveries at these gestations. However, despite some significant reductions [49,[56][57][58][59][60][61][62][63][64], the number of LPET births remains high. In 2021, almost 33,700 late preterm and more than 151,500 early term births were recorded in England and Wales [65].…”

Section: Introductionmentioning

confidence: 99%

Uncharted territory: a narrative review of parental involvement in decision-making about late preterm and early term delivery

Mielewczyk,

Boyle

2023

BMC Pregnancy Childbirth

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Almost 30% of live births in England and Wales occur late preterm or early term (LPET) and are associated with increased risks of adverse health outcomes throughout the lifespan. However, very little is known about the decision-making processes concerning planned LPET births or the involvement of parents in these. This aim of this paper is to review the evidence on parental involvement in obstetric decision-making in general, to consider what can be extrapolated to decisions about LPET delivery, and to suggest directions for further research.A comprehensive, narrative review of relevant literature was conducted using Medline, MIDIRS, PsycInfo and CINAHL databases. Appropriate search terms were combined with Boolean operators to ensure the following broad areas were included: obstetric decision-making, parental involvement, late preterm and early term birth, and mode of delivery.This review suggests that parents’ preferences with respect to their inclusion in decision-making vary. Most mothers prefer sharing decision-making with their clinicians and up to half are dissatisfied with the extent of their involvement. Clinicians’ opinions on the limits of parental involvement, especially where the safety of mother or baby is potentially compromised, are highly influential in the obstetric decision-making process. Other important factors include contextual factors (such as the nature of the issue under discussion and the presence or absence of relevant medical indications for a requested intervention), demographic and other individual characteristics (such as ethnicity and parity), the quality of communication; and the information provided to parents.This review highlights the overarching need to explore how decisions about potential LPET delivery may be reached in order to maximise the satisfaction of mothers and fathers with their involvement in the decision-making process whilst simultaneously enabling clinicians both to minimise the number of LPET births and to optimise the wellbeing of women and babies.

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Shifting Patterns in Cesarean Delivery Scheduling and Timing in Oregon before and after a Statewide Hard Stop Policy

Abstract: Oregon's hard stop policy limiting elective early-term cesarean delivery was associated with lower odds of cesarean delivery in the category of women who were targeted by the policy; more research is needed on impact of such policies on neonatal outcomes.

Cited by 7 publications

References 35 publications

Cesarean birth and maternal morbidity among Black women and White women after implementation of a blended payment policy

Cesarean birth and maternal morbidity among Black women and White women after implementation of a blended payment policy

A Systematic Review on the Effectiveness of Implementation Strategies to Postpone Elective Caesarean Sections to ≥39+(0-6) Week of Gestation.

Uncharted territory: a narrative review of parental involvement in decision-making about late preterm and early term delivery

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