Childbirth and social class: The case of cesarean delivery (original) (raw)
Related papers
The relationship between indicators of socioeconomic status and cesarean section in public hospitals
Revista de Saúde Pública, 2017
OBJECTIVE: To assess the relationship between indicators of socioeconomic status and cesarean section in public hospitals that adopt standardized protocols of obstetrical care. METHODS: This was a prospective cohort study conducted between May 2005 and January 2006 with 831 pregnant women recruited from 10 public primary care clinics in São Paulo, Brazil. Demographic and clinical characteristics were collected during pregnancy. The three main exposures were schooling, monthly family income per capita, and residential crowding. The main outcome was cesarean section at three public hospitals located in the area. Crude and adjusted risk ratios (RR), with 95% confidence intervals were calculated using Poisson regression with robust variance. We examined the effects of each exposure variable on cesarean section accounting for potential confounders by using four different models: crude, adjusted by mother's characteristics, by obstetrical complications, and by the other two indicators of socioeconomic status. RESULTS: Among the 757 deliveries performed in the public hospitals, 215 (28.4%) were by cesarean section. In the bivariate analysis, cesarean section was associated with higher family income per capita, higher education, lower residential crowding, pregnancy planning, white skin color, having a partner, and advanced maternal age. In the multivariate analysis, after adjustment for covariates, none of the socioeconomic status variables remained associated with cesarean section. CONCLUSIONS: In this group, the chance of women undergoing cesarean section was not associated with indicators of socioeconomic status only, but was defined in accordance with major obstetric and clinical conditions.
Paediatric and perinatal epidemiology, 2018
The existing inconsistent association between the caesarean rate and maternal socio-economic status (SES) may be the result of a failure to examine the association across indications for caesarean. This study examined the variation in caesarean rates by maternal SES across diverse obstetric-indications. Data on demographics, education, insurance status, medical-conditions, and obstetric characteristics needed to classify deliveries according to Robson's 10 obstetric-groups were extracted from the 2015 US birth certificate data (n = 3 988 733). Multivariable log-binomial regression was used to analyse the data adjusting for confounders. The caesarean rate was 34.1% for women with high SES and 26.8% for those with low SES. After adjustment for confounders, the rate was similar between women with graduate degrees and those who did not complete high school (relative risk (RR) 1.0, 95% confidence interval (CI) 0.9, 1.1). However, different rates of caesareans across SES were observed...
Variations in cesarean deliveries associated with payer type
Proceedings in Obstetrics and Gynecology, 2022
Objective: The rates of cesarean deliveries (CD) in the United States (U.S.) have been increasing since the 1990s making it the most common operating room procedure in U.S. hospitals. CD may be necessary due to a variety of medical indications; however, it is not clear whether socioeconomic factors affect CD rates. This study examines the association between type of insurance coverage pregnant women have and rates of CD in the U.S.Methods: This is a retrospective analysis of the discharge records of pregnant women admitted to U.S. hospitals between 2012 and 2014 extracted from the National Inpatient Sample dataset. The study population was divided into two groups according to insurance coverage (public vs private). Logistic regression analysis was used to examine the association between type of insurance and CD rates while controlling for an array of demographic, medical, social and behavioral confounding factors.Results: 12,450,349 subjects were included in the analysis, of those, ...
2016
In the last decade, the number of cesarean sections — or C-sections — performed in the United States has nearly doubled. In fact, according to the Centers for Disease Control, 32.2% of all deliveries in the U.S. are by Cesarean delivery. Of this percentage, it is estimated that approximately 7.7% of cesarean deliveries are carried out by maternal request, or for non-medical reasons (Curtin, 2016). With these statistics, it is important to understand the contributing factors that lead a mother to choose C-section delivery, especially when evaluating the 60% increase between 1996 and 2009. While nearly a third of all births are delivered by cesarean each year, we must ask ourselves why is this happening. An evaluation of the social forces at play might offer insight that could help healthcare providers in promoting original epidemiological studies and research, evidence-based education, risks, outcomes, and preventive measures. Ultimately, this would establish a foundation for prioritizing maternal and neonatal health alike, patient advocacy and imminent discussion regarding the future direction of healthcare in the United States (Dunkel-Schetter, 2011). There is no doubt that the rapid increase in elective cesarean births has been influenced by a wide range of factors. These factors not only influence women to choose cesarean delivery over vaginal delivery, but they also reveal manifestations of priority from the female perspective.
Journal of Nursing Education and Practice, 2014
The purpose of this study was to examine the relationship between the type and timing of commonly used intrapartum clinical factors and their relationship to birth outcomes. The factors included in the analysis were type of provider (midwife or obstetrician), place of birth (home or hospital), cervical dilation on admission, and commonly used labor interventions, namely use of continuous electronic fetal monitoring, epidural anesthesia and oxytocin on the type of birth (cesarean or vaginal birth). The research question guiding the analysis was: what factors increase the likelihood of cesarean birth (CB)? The findings reported here are parts of a larger mixed methods study that used three data collection methods: a projective test, a focus group, and a semi-structured postpartum interview. The study took place in an urban area in the mid-Atlantic United States and the sample was comprised of 49 low-risk primigravid women recruited between 28-36 weeks gestation. The analysis reported here only used data from the postpartum interview. During the interview, each woman reported the events of their labor and birth that were then mapped along a timeline. The findings show that admission to hospital early in labor played a key role in increasing the number of interventions used and was associated with increased risk of CB. The small, homogenous sample limited the ability to conduct more comprehensive statistical analysis and to generalize to more diverse groups, however, the proportional differences are highly suggestive and warrant further investigation.
Risk factors for cesarean section by category of health service
Revista De Saude Publica, 2010
OBJECTIVE: To analyze the rate of cesarean section and differences in risk factors by category of health service, either public or private. METHODS: A cross-sectional study was carried out including all pregnant women in labor admitted to hospitals in the city of Rio Grande, Southern Brazil, between January 1 and December 31, 2007. A pre-coded and pre-tested questionnaire was used to collect on social, demographic, obstetric and newborn care information. Two regression models were constructed: one for public users and the other one for private ones. Poisson regression was used in each model in the multivariate analysis. Prevalence rates and 95% confidence intervals were calculated for each adjusted factor. RESULTS: The rate of cesarean section was 43% and 86% among public and private users. Sociodemographic factors and twin births have a more significant impact among public users as well as number of pregnancies (25% vs. 13% reduction in public and private users, respectively) and previous cesarean section (86% vs. 24% increase in public and private users, respectively). Prenatal care visits and hospital admissions affected the outcome only in women users of public services. CONCLUSIONS: Cesarean section rates were high in both groups studied, but it was twice as high among women cared in the private sector. Associated factors differ in magnitude by category of service used.
On-demand cesarean section: assessing trends and socioeconomic disparities
Revista de Saúde Pública
OBJECTIVE: to measure prevalence, evaluate trends and identify socioeconomic differences of on-demand cesarean section in the municipality of Rio Grande (RS), extreme south of Brazil, in 2007, 2010, 2013 and 2016. METHODS: all the puerperae residing in this municipality who had cesarean deliveries in one of the only two local maternity hospitals in the period 01/01-31/12 of the aforementioned years were part of this transversal study. Puerperae were interviewed using a single, standardized questionnaire at the hospital within 48 hours after delivery. The outcome was assessed based on the mothers’ report that the cesarean section was performed according to their request. The analysis consisted of the observation of the outcome’s frequency in each year and the evaluation of its prevalence throughout this period through the chi-square linear trend test. Socioeconomic inequalities were assessed based on household income and women’s schooling using the Slope Index of Inequality and the R...
BMC Pregnancy and Childbirth, 2014
Background: Caesarean section (CS) rates especially without medical indication are rising worldwide. Most of indications for CS are relative and CS rates for various indications vary widely. There is an increasing tendency to perform CSs without medical indication on maternal request. Women with higher socioeconomic status (SES) are more likely to give birth by CS. We aimed to study whether giving birth by CS was associated with SES and other characteristics among singleton births during 2000-2010 in Finland with publicly funded health care. Methods: Data were gathered from the Finnish Medical Birth Register. The likelihood of giving birth by CS according to CS type (planned and non-planned), parity (nulliparous vs. multiparous), socio-demographic factors, delivery characteristics and time periods (2000-2003, 2004-2007 and 2008-2010) was determined by using logistic regression analysis. SES was classified as upper white collar workers (highest SES), lower white collar workers, blue collar workers (lowest SES), others (all unclassifiable cases) and cases with missing information. Results: In total, 19.8% (51,511 of 259,736) of the nulliparous women and 13.1% (47,271 of 360,727) of the multiparous women gave birth by CS. CS was associated with several delivery characteristics, such as placental abruption, placenta previa, birth weight and fear of childbirth, among both parity groups. After adjustment, the likelihood of giving birth by planned CS was reduced by 40% in nulliparous and 55% in multiparous women from 2000-2003 to 2008-2010, whereas the likelihood of non-planned CSs did not change. Giving birth by planned and non-planned CS was up to 9% higher in nulliparous women and up to 17% higher in multiparous women in the lowest SES groups compared to the highest SES group. Conclusions: Giving birth by CS varied by clinical indications. Women with the lowest SES were more likely to give birth by CS, indicating that the known social disparity in pregnancy complications increases the need for operative deliveries in these women. Overall, the CS policy in Finland shows favoring a trial of labor over planned CS and reflects no inequity in healthcare services.
Disparities in cesarean rates in the United States represent an important social problem because cesareans are related to maternal deaths and to the high cost of American health care. There are pervasive racial-ethnic and socioeconomic disparities in maternity care as in health care more generally, yet there has been little scrutiny of how overuse of cesarean deliveries might be linked to these disparities. There are at least two possibilities when it comes to c-sections: black, Hispanic, Native American, and low socioeconomic status (SES) mothers could be less likely to have needed cesareans, leading to more negative outcomes for both mothers and babies, or they could be more likely to have medically unnecessary cesareans, leading to more negative outcomes as a result of the surgery itself. This research uses data on all recorded births in the United States in 2006 to analyze differences in the odds of a cesarean delivery by race-ethnicity and SES. The analysis reveals that non-Hispanic black, Hispanic/Latina, and Native American mothers are more likely to have cesarean deliveries than non-Hispanic white or Asian mothers. Also, after accounting for medical indications, increasing education is associated with a decline in odds of a cesarean delivery, especially for non-Hispanic whites. The results suggest that high cesarean rates are an indicator of low-quality maternity care, and that women with racial and socioeconomic advantages use them to avoid medically unnecessary cesarean deliveries rather than to request them.