A lifecourse approach to understanding birth delivery methods in the US: Importance of preconception and pregnancy-related determinants

OBJECTIVE: To evaluate preconception and pregnancy-related determinants of birth delivery methods in the US.

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.