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APHA Scientific Session and Event Listing |
Isabel A. Cáceres, MMath1, Bruce B. Cohen, PhD1, Malena Hood, MPH1, Wanda Barfield, MD, MPH2, James K. West, PhD1, and Brooke A. Kinniburgh, MPH3. (1) Division of Research and Epidemiology, Center for Health Information, Statistics, Research and Evaluation, Massachusetts Department of Public Health, 250 Washington Street, 6th floor, Boston, MA 02108, 617-624-5669, isabel.caceres@state.ma.us, (2) Statistics & Evaluation, Massachusetts Dept. of Public Health, 250 Washington Street, Fifth Floor, Boston, MA 02108, (3) Statistics & Evaluation, Massachusetts Department of Public Health, 250 Washington Street, Fourth Floor, Boston, MA 02108
Background: C-section delivery is the most common major surgery in U.S. hospitals. Massachusetts has among the nation's highest rates; almost 1 in 3 deliveries occur via C-section and the rate has increased 57% over the last 5 years. Some C-section deliveries, particularly among primiparous low risk women may be unnecessary.
Study Question: Are Low Risk Women for Cesarean ‘Low Risk' in Massachusetts?
Methods: Using all live births to 2004 Massachusetts residents, we applied Centers for Disease Control and Prevention definitions for low risk women (LRW) for C-section (singleton infant, vertex position, gestational age 37+weeks). We also created a ‘lowest-risk' group of women [LRW for primiparous mothers <30 yrs with only normal birth weight infants (2500-4000g) and normal gestational age (37-42wk)]. We compared rates of C-section among primiparous LRW and Lowest-risk by maternal age, education, race/ethnicity, and insurance status. We also assessed deliveries for any maternal medical conditions or labor and delivery complications. Results: In 2004, 22,892 (31%) of Massachusetts births were C-sections and 27% occurred among primiparous LRW. Higher C-section rates occurred among women > 30 yrs, >HS educated, black, or privately insured. Among ‘lowest-risk' women C-sections occurred at 20%, and similar demographic patterns were seen. Once births with any maternal medical or labor/delivery complications were excluded, C-section rates for these women were 18% and 3%, respectively.
Conclusions: High proportions of C-sections occur among LRW in Massachusetts. However, rates vary by definition criteria and further work is needed to understand the contributors to increasing C-sections in MA and the US.
Learning Objectives:
Keywords: Maternal and Child Health, Pregnancy
Presenting author's disclosure statement:
Any relevant financial relationships? No
The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA