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APHA Scientific Session and Event Listing

Recorded presentation

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:

• Examine a new and modified category, “lowest risk”, for women having a Cesarean delivery.
• Understand the utility of the birth certificate for population base surveillance of perinatal issues
• Identify factors associated with elevated Cesarean rates for lowest risk women

Keywords: Maternal and Child Health, Pregnancy

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation