A Longitudinal Analysis of Maternal Outcomes of Repeat Cesarean Sections

Background. The current level of cesareans, (32.9% in 2009) is unprecedented for the U.S. and has led to growing concerns associated with the impact of repeat cesarean deliveries on both maternal and infant health outcomes. Prior research on the effects of repeat cesareans has been handicapped by the use of cross-sectional designs comparing mothers of different parity rather than the same mothers across their first and subsequent birth experiences. Methods. This study draws on the PELL database, a longitudinal dataset linking birth certificate to hospital discharge data in Massachusetts from 1998-2007, a total of 801,953 deliveries. We focus on the 116,350 women who had their first and second births recorded in the database, including, 27,264 women with two cesareans and 3,385 women with a primary cesarean followed by a VBAC. The outcomes are maternal morbidity measured by hospitalization across key perinatal periods (1st pregnancy; interpregnancy interval; 2nd pregnancy; 1 year postpartum to second birth) with upcoming multivariate analysis controlling for demographic and medical risk factors. Results. Preliminary examination found distinct patterns of hospitalization across the four possible combinations of delivery method. Mothers with consecutive cesareans had the highest rates of hospitalization prior to the first cesarean (18.9%); mothers with a vaginal birth followed by a cesarean had the highest rates of hospitalization in the interpregnancy interval (9.0%), during the second pregnancy (19.1%) and after the second birth (4.4%). Mothers with a primary cesarean followed by a VBAC generally had the lowest hospitalization rates across the four periods studied.