Online Program

Effect of Labor Induction, Epidural Analgesia and Centimeters Dilated at Hospital Admission on Risk of Cesarean Delivery at First Childbirth

Wednesday, November 4, 2015 : 1:15 p.m. - 1:30 p.m.

Kristen Kjerulff, MA, PhD, Public Health Sciences, Penn State University College of Medicine, Hershey, PA
Junjia Zhu, PhD, Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, PA
Background:  Nearly a third of all births in the US are by cesarean delivery (CD) and 60% of CDs are to first-time mothers.  Although there are efforts to reduce the CD rate in the US, risk factors are not well understood.  

Methods:  As part of a large-scale cohort study, we investigated risk factors for unplanned CD (n = 2,851) via logistic regression, controlling for confounding factors, including pre-pregnancy BMI, height, age and gestational weight gain.

Results:  35.6% were induced - which more than doubled risk of CD (odds ratio (OR = 2.3 (95% confidence interval (CI) = 2.0-2.8).  Epidural analgesia also increased women’s risk of CD and among women who were induced and received epidural analgesia, 36.0% had a CD, while among those who were not induced and did not receive epidural analgesia 8.1% did (OR = 15.2, 95% CI = 7.7-29.9). Centimeters dilated at hospital admission was also significantly associated with risk of CD.  More than half (52.1%) who were 0 centimeters dilated at hospital admission had CD, while among those who were dilated at least 5 centimeters, 11.4% did.  In logistic regression with induction, epidural use, and centimeters dilated, controlling for confounding factors, all 3 of these predictors remained significant (p < .01) and centimeters dilated was the most significant (p < .0001).

Conclusions:  Three treatment-related factors significantly and independently increase a woman’s risk of having an unplanned CD at first childbirth – hospital admission at less than 5 centimeters dilation, labor induction and use of epidural analgesia.

Learning Areas:

Planning of health education strategies, interventions, and programs
Public health or related nursing

Learning Objectives:
List 5 risk factors for cesarean delivery at first childbirth Describe the effect of labor induction and use of epidural analgesia on risk of cesarean delivery at first childbirth Articulate at least one hypothesis that could explain the associations found in this study between labor induction and epidural use in relation to the occurrence of unplanned cesarean delivery

Keyword(s): Birth Outcomes, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am principal investigator of the study described in the abstract, I have masters and doctoral degrees in psychology, and have been conducting research in the area of women's health for the past 25 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.