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APHA Scientific Session and Event Listing

Maternal outcomes when prior cesarean is the only indication for a repeat cesarean, Massachusetts, 1998-2003

Jessica A. Taubner, MPH candidate1, Eugene Declercq, PhD1, Mary Barger, CNM, MPH1, Howard Cabral, PhD2, Stephen R. Evans, MPH3, Milton Kotelchuck, MPH, PhD1, and Judith Weiss, ScD1. (1) Department of Maternal and Child Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, 508-981-3537, jtaubner@bu.edu, (2) Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, (3) Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108

Background: Between 1998 and 2003, Massachusetts, mirroring national trends, experienced a decline in the rate of vaginal birth after cesareans (VBAC) from 62% to a record low of 12.6%. Policy and practice changes have led “prior cesarean” to being a sufficient justification for a repeat cesarean, regardless of any other indication. This study examines the outcomes of repeat cesareans and vaginal births when there are no medical indications. Methods: Data for these analyses were obtained from the Pregnancy through Early Life Longitudinal (PELL) Data System. This data system links Massachusetts birth certificates, fetal death records, and birth-related hospital discharge data for mothers and infants. We used data from 470,857 linked records for births to Massachusetts residents in Massachusetts hospitals from 1/1/98 – 12/31/03. The study population was women with a prior cesarean and had “no indicated risk” (NIR) for the subsequent delivery (n = 27,185). Outcomes were postpartum rehospitalizations and costs. Findings: In 1998 half (50%) of mothers with prior cesareans and no medical indications had a repeat cesarean. By 2003, the rate of repeat cesareans with no medical indication in Massachusetts was 82%. The rate of NIR repeat cesareans increased substantially by maternal age. Women with NIR repeat cesareans were significantly more likely to be rehospitalized for delivery-related complications in the first month and first year postpartum compared to mothers with a VBAC. The average costs for NIR cesareans were 50% higher than NIR VBACs. Conclusion: NIR repeat cesarean sections result in increased risk of postpartum hospitalizations and greater costs.

Learning Objectives: At the conclusion of the session, the participants in this session will be able to

Keywords: Maternal Health,

Presenting author's disclosure statement:

Any relevant financial relationships? No

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