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

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

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