A lifecourse approach to understanding birth delivery methods in the US: Importance of preconception and pregnancy-related determinants
METHODS: Data are from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative, population-based survey of women delivering a live baby in 2001 (n=9,350). Delivery methods included: 1) vaginal delivery (reference); 2) non-elective C-section; and 3) elective C-section. Non-elective C-sections were classified as C-sections accompanied by labor complications or preterm delivery (<37 weeks). Elective C-sections were defined as C-sections occurring without any labor complication. Using multinomial logistic regression, we examined the role of sociodemographics, health, healthcare, stressful life events (before and during pregnancy), pregnancy complications, and history of C-section on the odds of elective and non-elective C-sections.
RESULTS: 74.2% of women delivered vaginally, 14.2% had a non-elective C-section, and 11.6% had an elective C-section. Women had higher odds of a non-elective C-section if they had experienced any preconception stressful life event, a prior C-section, any pregnancy complication, were older, obese, delivered multiples, or were living in the South. Women had higher odds of an elective C-section if they had a prior C-section, were older, obese, or delivered multiples.
CONCLUSIONS: Over 25% of US women delivered their babies by C-section, with 45% of these C-sections being elective. Prior C-section delivery was the strongest predictor of elective and non-elective C-sections. Preconception stressful life events contribute to the risk for non-elective C-section and present an opportunity for intervention. Reducing the number of C-sections is warranted to lower the risks for deleterious health outcomes across the lifecourse.
Public health or related research
Social and behavioral sciences
Describe the prevalence of vaginal, non-elective C-section and elective C-section deliveries in the US. Discuss the preconception and pregnancy-related determinants of non-elective and elective C-section deliveries. Discuss programmatic and policy implications of our findings.
Keyword(s): Pregnancy Outcomes, Stress
Qualified on the content I am responsible for because: I have been the principal or co-principal of multiple federally funded grants focusing on the maternal and child health. Among my scientific interests has been the application of the life course approach to understanding the social, behavioral, and psychological factors that contribute to human development and disparities in health and healthcare in women, children, and families.
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.