DPM Research Fellow, Lauren Wisk, PhD and colleagues designed a study that takes a life course approach to understanding the factors contributing to delivery methods in the US. Three delivery methods were examined --vaginal delivery, medically-indicated C-section, and non-medically indicated C-section – using data from a large, national, population-based survey of over 9,000 women.
The life course model suggests that perinatal health may be influenced by numerous events across the lifespan, as well as by intergenerational effects. Thus, using multinomial logistic regression, the researchers examined the role of socio-demographics, health, healthcare, stressful life events, pregnancy complications, and history of C-section on the odds of medically- and non-medically indicated C-sections, compared to vaginal delivery.
Results indicated that prior C-section was the strongest predictor of both medically- and non-medically indicated C-sections. As such, clinicians need to discuss with their patients possible health problems associated with multiple C-sections and should follow guidelines of the American College of Obstetricians and Gynecologists.
But there were marked differences in the risk factors for indicated and non-indicated C-sections. Compared to women delivering vaginally, those who had unnecessary C-sections were more likely to have had a prior C-section, one or more prior live births, pre-pregnancy obesity, or were 35+ years old. To reduce such inappropriate utilization, best practice guidelines should be discussed with doctors and patients and provider incentives should be examined.
Women whose C-sections were medically-indicated were more likely to have had any pregnancy complication, any chronic condition, given birth to multiples, no prior live births, and were the least likely to live in the West compared to women who delivered vaginally. Here, clinical or programmatic activities may need to be implemented prior to conception.
Surprisingly, stressful life events during pregnancy, health insurance during pregnancy, the time prenatal care was started, maternal race/ethnicity, marital status, SES, and urbanicity were not associated with delivery method.