Navigation Links
Pregnant women's likelihood of cesarean delivery in Massachusetts linked to choice of hospitals
Date:3/18/2013

Boston, MA There is wide variation in the rate of cesarean sections performed at different hospitals across the U.S. and one explanation has been that hospitals with higher c-section rates serve greater numbers of women at high risk for the procedure. Now, a new study by researchers from Harvard School of Public Health (HSPH) and the Massachusetts Department of Public Health provides the strongest evidence to date that it's not just medical need that determines who has c-sections, but also something at the hospital levelin other words, the same woman would have a different chance of undergoing a c-section based on the hospital she chooses.

The findings suggest that certain hospitals' high rates of cesarean births have more to do with characteristics of the hospitals themselves than with characteristics of their patients.

"Even after taking into account factors that put women at risk of having a c-section, such as age, and pre-existing health conditions, some hospitals still have higher rates of c-section delivery than others," said senior author S V Subramanian, professor of population health and geography at HSPH. Put simply, for two women with a similar observed risk profile, one might have a c-section delivery and one might not, depending on which hospital they go to, he said.

The study appears in the March 18, 2013 online issue of the journal PLOS ONE. The article will be available after the embargo lifts at this link: http://dx.plos.org/10.1371/journal.pone.0057817.

While c-sections can be a lifesaving procedure for an infant in distress, or when there are multiple births or other labor complications, c-sections that are not medically necessary can put mothers and babies at avoidable risk of infection, extend hospital stays and recoveries, and increase health costs. In spite of these risks, c-section rates have been increasing in the U.S. over the past 17 years. Mirroring the national trend, cesarean deliveries in Massachusetts have increased steadily since 1997. In 2009, about one-third of all births in Massachusetts were by c-sectionup 61% from 1998.

In 2008, the Massachusetts Department of Public Health invited local clinicians and researchers to partner with state health officials in a study to better understand why c-section rates have been rising in Massachusetts. The HSPH, Boston University, Massachusetts General Hospital, and Massachusetts Department of Public Health team, using data from the Pregnancy to Early Life Longitudinal data system, analyzed 228,864 births in Massachusetts' 49 hospitals with maternity services from 2004-200698% of all births during that period.

The researchers found that about 27% of first-time mothers in Massachusetts having single, vertex (head-first) presentation, full-term infants from 2004-2006 had c-sections. C-section rates in Massachusetts hospitals varied from 14% to 38% even among this low-risk group.

Previous research had been unable to offer clear answers on whether variations in hospitals' c-section rates had simply to do with hospitals' different case mix. But the new research findings, say the authors, show with more certainty that a mother's risk of c-section really is influenced by her choice of hospital. "This is the first time that anyone has shown this problem exists right here in Massachusetts, which is widely considered to be one of the world's premier health care hubs," said Mariana Arcaya, research scientist at the Harvard Center for Population and Development Studies and co-author of the study.

The findings suggest that hospital practices and culture are important determinants of a hospital's c-section rate, said lead author Isabel A. Cceres, who was an epidemiologist at the Massachusetts Department of Public Health at the time of the study. Though this study did not pinpoint which hospital factors were at play, the authors highlighted previous studies suggesting that liability and insurance, being a teaching hospital, hospital admission practices, and the presence of midwives may influence c-section rates. Lack of clinical guidelines or standards on when a cesarean should be performed also may help explain why hospital rates are so variable.

The researchers said that hospitals should re-examine their procedures for deciding when to perform c-sections to make sure that medical neednot other factors such as doctor preferences or fear of liabilitydetermine how babies are delivered.


'/>"/>

Contact: Marge Dwyer
mhdwyer@hsph.harvard.edu
617-432-8416
Harvard School of Public Health
Source:Eurekalert

Related medicine news :

1. Heavier Pregnant Women May Face Higher C-Section Risk
2. Study shows reduced risk of preterm birth for pregnant women vaccinated during pandemic flu
3. Low-income pregnant women in rural areas experience high levels of stress, researcher says
4. Whooping Cough Vaccine for Pregnant Women Among New Recommendations
5. New study examines post-Roe v. Wade arrests of and forced interventions on pregnant women
6. When Can You Get Pregnant? Many Women Don’t Know, But a Simple Family Planning Method Now Available from Cycle Technologies Can Help
7. Study Questions Advice Given to Obese Pregnant Women
8. More help needed to improve smoking cessation services for pregnant women with mental disorders
9. BPA shown to disrupt thyroid function in pregnant animals and offspring
10. Pregnant Women With Bipolar Disorder May Have Higher Risk of Premature Birth
11. New study finds majority of pregnant women require an average of 2 months sick leave from work
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/23/2017)... ... June 23, 2017 , ... Ulster University, Magee Campus ... from 9 am to 3 pm to present to graduate students exciting new and ... an original curriculum project led by The Health Improvement Service of the Western Health ...
(Date:6/23/2017)... ... June 23, 2017 , ... Radabaugh & Associates, ... families and business owners in North Central West Virginia, is embarking on a ... differently abled residents in the region. , The Stepping Stones organization offers a ...
(Date:6/22/2017)... Indianapolis, IN (PRWEB) , ... June 22, 2017 ... ... employee benefits advisory organization, is pleased to welcome Whipple & Company as its ... on the clear purpose of balancing their clients’ risk while tailoring optimized benefit ...
(Date:6/22/2017)... , ... June 22, 2017 , ... ... awards for environmental excellence. Maryland Recycling Network has awarded the Baltimore VA Medical ... Outstanding Small Government Program Award for its efforts to promote waste reduction and ...
(Date:6/20/2017)... ... June 20, 2017 , ... ... that Claritas Capital, a Nashville-based private equity firm, has invested $3.35 million in ... for some time, and Claritas Capital offers the smart money, speed to market ...
Breaking Medicine News(10 mins):
(Date:6/8/2017)... 8, 2017  Less than a month ago, amateur ... 200,000 companies, including hospital networks, in over 150 countries. ... of the largest online extortion attempts ever recorded. With ... it is imperative that providers understand where the risks ... this — and many other very real cyber threats.  ...
(Date:6/7/2017)... GAITHERSBURG, Md. , June 7, 2017  Novavax, Inc., ... the second of two Phase 2 trials of its RSV ... women of child bearing age have been published in the ... this publication have been shared in prior scientific conferences). The ... trial in April 2014. Novavax is developing the RSV F ...
(Date:6/3/2017)... -- Eli Lilly and Company (NYSE: LLY ... 3 MONARCH 2 study showed that abemaciclib, a ... with fulvestrant, significantly improved progression-free survival (PFS) compared ... hormone-receptor-positive (HR+), human epidermal growth factor receptor 2-negative ... progressed after endocrine therapy (median PFS, 16.4 vs. ...
Breaking Medicine Technology: