Featured Research

from universities, journals, and other organizations

Pregnant women's likelihood of Cesarean delivery in Massachusetts linked to choice of hospitals

Date:
March 18, 2013
Source:
Harvard School of Public Health
Summary:
A new study provides the strongest evidence to date that it's not just medical need that determines who has a Cesarean section, but also something at the hospital level -- in other words, the same woman would have a different chance of undergoing a C-section based on the hospital she chooses.

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 level -- in 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.

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-section -- up 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 2004-2006 -- 98% 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. Cαceres, 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 need -- not other factors such as doctor preferences or fear of liability -- determine how babies are delivered.


Story Source:

The above story is based on materials provided by Harvard School of Public Health. Note: Materials may be edited for content and length.


Journal Reference:

  1. Isabel A. Cαceres, Mariana Arcaya, Eugene Declercq, Candice M. Belanoff, Vanitha Janakiraman, Bruce Cohen, Jeffrey Ecker, Lauren A. Smith, S. V. Subramanian. Hospital Differences in Cesarean Deliveries in Massachusetts (US) 2004–2006: The Case against Case-Mix Artifact. PLoS ONE, 2013; 8 (3): e57817 DOI: 10.1371/journal.pone.0057817

Cite This Page:

Harvard School of Public Health. "Pregnant women's likelihood of Cesarean delivery in Massachusetts linked to choice of hospitals." ScienceDaily. ScienceDaily, 18 March 2013. <www.sciencedaily.com/releases/2013/03/130318180408.htm>.
Harvard School of Public Health. (2013, March 18). Pregnant women's likelihood of Cesarean delivery in Massachusetts linked to choice of hospitals. ScienceDaily. Retrieved October 22, 2014 from www.sciencedaily.com/releases/2013/03/130318180408.htm
Harvard School of Public Health. "Pregnant women's likelihood of Cesarean delivery in Massachusetts linked to choice of hospitals." ScienceDaily. www.sciencedaily.com/releases/2013/03/130318180408.htm (accessed October 22, 2014).

Share This



More Health & Medicine News

Wednesday, October 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Orthodontist Mom Jennifer Salzer on the Best Time for Braces

Orthodontist Mom Jennifer Salzer on the Best Time for Braces

Working Mother (Oct. 22, 2014) — Is your child ready? Video provided by Working Mother
Powered by NewsLook.com
U.S. Issues Ebola Travel Restrictions, Are Visa Bans Next?

U.S. Issues Ebola Travel Restrictions, Are Visa Bans Next?

Newsy (Oct. 22, 2014) — Now that the U.S. is restricting travel from West Africa, some are dropping questions about a travel ban and instead asking about visa bans. Video provided by Newsy
Powered by NewsLook.com
US to Track Everyone Coming from Ebola Nations

US to Track Everyone Coming from Ebola Nations

AP (Oct. 22, 2014) — Stepping up their vigilance against Ebola, federal authorities said Wednesday that everyone traveling into the US from Ebola-stricken nations will be monitored for symptoms for 21 days. (Oct. 22) Video provided by AP
Powered by NewsLook.com
Doctors Help Paralysed Man Walk Again, Patient in Disbelief

Doctors Help Paralysed Man Walk Again, Patient in Disbelief

AFP (Oct. 22, 2014) — Polish doctors describe how they helped a paralysed man walk again, with the patient in disbelief at the return of sensation to his legs. Duration: 1:04 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins