Caesarian-Sections (C-Sections) and Vaginal Deliveries in Hawaii: 2005-2009

Problem: Almost one-third of Hawaii's births are to women on Medicaid, however little is known about how their maternal and child health (MCH) outcomes, including delivery methods, compared with privately-insured women, who represent over half of all births,

Study Purpose: A descriptive analysis on 88,000 Hawaii births was completed to (1) identify factors associated with delivery method (C-section versus vaginal delivery) and (2) estimate the associations between delivery method, insurance status (Medicaid versus private insurance) and Caesarian sections (C-sections) versus vaginal deliveries outcome. This is the last of a 4-part analysis of labor and delivery data from Hawaii's birthing hospitals.

Method: Hospital discharge data representing all births in Hawaii hospitals from January 1, 2005 through June 30, 2009 were linked (mother to baby), extracted, and analyzed. Descriptive and inferential statistics were computed on mother and newborn variables to identify factors and estimate associations.

Findings: Compared to women with vaginal deliveries (73%), C-section mothers (27%) were more likely to be white, on private health care insurance/non-Medicaid, living in a rural area outside of Honolulu, and diagnosed with hypertension or gestational diabetes. Premature and high or very low birth-weight infants were more likely to be delivered via C-section than vaginally.

Implications: Findings suggest that there are socio-demographic, insurance-related and medical outcome-related variables in the prevalence of C-sections versus vaginal deliveries occurring in Hawaii.