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APHA Scientific Session and Event Listing

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

• Describe the trends in no indicated risk VBACs and repeat cesareans in Massachusetts between 1998 and 2003.
• Describe the postpartum hospital outcomes and related costs among women who had no indicated risk repeat cesareans compared to women who had no indicated risk VBACs.
• Recognize the important clinical and policy implications of postpartum hospital outcomes and related costs for women who have no indicated risk repeat cesareans.

Keywords: Maternal Health,

Presenting author's disclosure statement:

Any relevant financial relationships? No