(SDAS) The Impact of Multiple Cesarean Sections on Maternal Internatal and Newborn Health
Grantee: Trustees of Boston University, BUMC
Principal Investigator: Eugene Declercq
Project Number: R40MC17172
Project Date: 02/01/2010
Final Report
Age group(s)
- Women/Maternal
- Perinatal/Infancy (0-12 months)
Abstract
This research is intended to inform providers and policymakers concerning the public health impact of 1.3 million cesarean births annually in the U.S. The current U.S. level (33.1% in 2007) is unprecedented and may have consequences, positive and negative, that are not yet understood. These changes have drawn the attention of the provider, research, and policy communities including a 2010 NIH meeting entitled, Vaginal Birth After Cesarean: New Insights. Prior research has generally been handicapped by: reliance on small hospital level databases with limited statistical power; cross sectional designs that can only stratify results by numbers of cesareans and cannot follow the health of mothers in the internatal period or stratify their results to examine racial and ethnic disparities in the results. Research Design and Methods: This study relies on the Pregnancy to Early Life Longitudinal (PELL) Data System. PELL is a population-based longitudinal reproductive data system. The core of PELL consists of the annual linkage of all Massachusetts birth (BC) and fetal death (FD) certificate records with the birth-related hospital discharge (HD) records of both mother and infant. This study will make particular use of two key longitudinal linkages in the PELL data system: (a) the linkage of successive deliveries and (b) hospitalizations, observational stays and emergency department visits. We can therefore identify internatal hospital contacts and we can use the combination of BC & HD data to refine measures of key variables. We are proposing three major study questions analyzing Massachusetts residents who had a singleton first birth in a Mass. hospital and at least one subsequent singleton birth or fetal death also in a Mass. hospital between 1998 and 2007. In second births different combinations of delivery method (e.g. vaginal/vaginal; vaginal/primary ces.; primary ces/repeat ces; and primary ces/VBAC) are compared as is the case for mothers with 3 births in the study period. From 1998-2006 there were 317,795 primiparous mothers in PELL including 22,971 mothers with two cesareans and 2,974 mothers with 3 cesareans. 1. Maternal Health Outcomes. What is the impact of method of delivery on maternal morbidities (hospitalization rates and diagnoses) associated with the internatal interval prior to subsequent births; the outcome of those births; and postpartum health? 2. Infant Health Outcomes. What is the impact of method of delivery on stillbirth rates, perinatal, feto-neonatal and feto-infant mortality and morbidity associated with second and third births? 3. Disparities. The above results will be stratified by race ethnicity to examine possible differences in maternal and infant health outcomes associated with repeat cesareans. Relationship to MCHB Strategic Research Issues: This research is particularly related to Strategic Research Issues II (elimination of health disparities), III (assurance of quality of care) and IV (development of healthy populations).Publications
Listed is descending order by year published.
Liberman RF, Getz KD, Heinke D, et al. Assisted reproductive technology and birth defects: effects of subfertility and multiple births. Birth Defects Res. 2017;109(14):1144-1153.
MacDorman MF, Declercq E, Thoma ME. Trends in maternal mortality by socio-demographic characteristics and cause of death in 27 states and the District of Columbia. Obstet Gynecol. 2017;129(5):811-818.
Plough AC, Galvin G, Li Z, et al. Relationship between labor and delivery unit management practices and maternal outcomes. Obstet Gynecol. 2017;130(2):358-365.
Sherman BS, Hoen R, Lee J, Declercq E. Doctor of public health educatin and training: where are we now? Public Health Reports. 2017;132(1):115-120.
Kennedy HP, Yoshida S, Costello A, et al. Asking different questions: research priorities to improve the quality of care for every woman, every child. Lancet Glob Health. 2016;4(11):e777-779.
Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Major survey findings of listening to mothers (SM) III: New mothers speak out: Report of national surveys of women's childbearing experiences conducted October-December 2012 and January-April 2013. J Perinat Educ. 2014 Winter;23(1):17-24.
Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Major survey findings of listening to mothers (SM) III: Pregnancy and birth: Report of the third national U.S. survey of women's childbearing experiences. J Perinat Educ. 2014 Winter;23(1):9-16.
Macdorman MF, Matthews TJ, Declercq E. Trends in out-of-hospital births in the United States, 1990-2012. NCHS Data Brief. 2014 Mar;(144):1-8.
Cáceres IA, Arcaya M, Declercq E, Belanoff CM, Janakiraman V, Cohen B, Ecker J, Smith LA, Subramanian SV. Hospital differences in cesarean deliveries in Massachusetts (US) 2004-2006: the case against case-mix artifact. PLoS One. 2013;8(3):e57817.
Declercq E. The absolute power of relative risk in debates on repeat cesareans and home birth in the United States. J Clin Ethics. 2013 Fall;24(3):215-24.
Declercq E. The politics of home birth in the United States. Birth. 2012 Dec;39(4):281-5.
Declercq E. Trends in midwife-attended births in the United States, 1989-2009. J Midwifery Womens Health. 2012 Jul-Aug;57(4):321-326.
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