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Rates and Predictors of Caesarean Section for First and Second Births: A Prospective Cohort of Australian Women

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Abstract

Objective To determine rates of vaginal delivery, emergency caesarean section, and elective caesarean section for first and second births in Australia, and to identify maternal predictors of caesarean section. Methods Data were from the Australian Longitudinal Study on Women’s Health. A total of 5275 women aged 18–38 years, who had given birth to their first child between 1996 and 2012 were included; 75.0% (n = 3956) had delivered a second child. Mode of delivery for first and second singleton birth(s) was obtained from longitudinal survey data. Socio-demographic, lifestyle, anthropometric and medical history variables were tested as predictors of mode of delivery for first and second births using multinomial logistic regression. Results Caesarean sections accounted for 29.1% (n = 1535) of first births, consisting of 18.2% emergency and 10.9% elective caesareans. Mode of delivery for first and second births was consistent for 85.5% of women (n = 3383) who delivered both children either vaginally or via caesarean section. Higher maternal age and body mass index, short-stature, anxiety and having private health insurance were predictive of caesarean section for first births. Vaginal birth after caesarean section was more common in women who were older, short-statured, or had been overweight or obese for both children, compared to women who had two vaginal deliveries. Conclusions for Practice Rates of caesarean section in Australia are high. Renewed efforts are needed to reduce the number of unnecessary caesarean births, with particular caution applied to first births. Interventions could focus on elective caesareans for women with private health insurance or a history of anxiety.

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References

  • Allen, V. M., O’Connell, C. M., Farrell, S. A., et al. (2005). Economic implications of method of delivery. American journal of obstetrics and gynecology, 193(1), 192–197. doi:10.1016/j.ajog.2004.10.635.

    Article  PubMed  Google Scholar 

  • Appropriate technology for birth. (1985). Lancet, 2(8452), 436–437.

    Google Scholar 

  • Australian Bureau of Statistics. (2014). Remoteness structure. Commonwealth of Australia, Canberra. Retrieved January 9, 2015.

  • Australian Government Health insurance explained. (2015). Health insurance explained. Retrieved January 12, 2015, from http://www.privatehealth.gov.au/healthinsurance/whatiscovered/.

  • Australian Institute of Health and Welfare. (2015) Australia’s mothers and babies 2013—In brief. Canberra AIHW, Perinatal statistics series No. 31. Cat No. PER 72.

  • Betran, A. P., Torloni, M. R., Zhang, J., et al. (2015). What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reproductive Health, 12, 57. doi:10.1186/s12978-015-0043-6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, W. J., Bryson, L., Byles, J. E., et al. (1998). Women’s Health Australia: Recruitment for a national longitudinal cohort study. Women & Health, 28, 23–40.

    Article  CAS  Google Scholar 

  • Brown, W. J., Ford, J. H., Burton, N. W., et al. (2005). Prospective study of physical activity and depressive symptoms in middle-aged women. American journal of preventive medicine, 29(4), 265–272. doi:10.1016/j.amepre.2005.06.009.

    Article  PubMed  Google Scholar 

  • Crowther CA, Dodd JM, Hiller JE, et al. (2012). Planned vaginal birth or elective repeat caesarean: Patient preference restricted cohort with nested randomised trial. PLoS medicine. 9(3):e1001192. doi:10.1371/journal.pmed.1001192.

    Article  PubMed  PubMed Central  Google Scholar 

  • Day P, Sullivan EA, Lancaster P. Australia’s mothers and babies 1996. In: Unit AloHaWNPS, editor. Sydney 1999.

  • Gresham E, Forder P, Chojenta CL, et al. (2015) Agreement between self-reported perinatal outcomes and administrative data in New South Wales, Australia. BMC Pregnancy and Childbirth. 15:161. doi:10.1186/s12884-015-0597-x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Halvorsen, L., Nerum, H., Sorlie, T., et al. (2010). Does counsellor’s attitude influence change in a request for a caesarean in women with fear of birth? Midwifery, 26(1), 45–52. doi:10.1016/j.midw.2008.04.011.

    Article  PubMed  Google Scholar 

  • Hamilton, B., Martin, J., Osterman, M., et al. (2015) Births: Final data for 2014. National Vital Statistics Reports 2015; 64(12), 1–64.

    Google Scholar 

  • Hilder, L., Zhichao, Z., Parker, M., et al. (2014). Australia’s mothers and babies 2012. Canberra: AIHW.

    Google Scholar 

  • Hoffman, J. R., & Kanzaria, H. K. (2014). Intolerance of error and culture of blame drive medical excess. Bmj, 349, g5702. doi:10.1136/bmj.g5702.

    Article  PubMed  Google Scholar 

  • Hure, A. J., Chojenta, C. L., Powers, J. R., et al. (2014). Validity and reliability of stillbirth data using linked self-reported and administrative datasets. Journal of Epidemiology / Japan Epidemiological Association.

  • Khan A, Zaman S. (2010) Costs of vaginal delivery and caesarean section at a tertiary level public hospital in Islamabad, Pakistan. BMC Pregnancy and Childbirth. 2010; 10:2. doi:10.1186/1471-2393-10-2.

  • Laursen, M., Hedegaard, M., Johansen, C., et al. (2008). Fear of childbirth: Predictors and temporal changes among nulliparous women in the Danish National Birth Cohort. BJOG: An International Journal of Obstetrics and Gynaecology, 115(3), 354–360. doi:10.1111/j.1471-0528.2007.01583.x.

    Article  CAS  Google Scholar 

  • Lee, C., Dobson, A. J., Brown, W. J., et al. (2005). Cohort profile: The Australian longitudinal study on women’s health. International journal of epidemiology, 34(5), 987–991.

    Article  PubMed  Google Scholar 

  • Lumbiganon, P., Laopaiboon, M., Gulmezoglu, A. M., et al. (2010). Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007–08. Lancet, 375(9713), 490–499. doi:10.1016/S0140-6736(09)61870-5.

    Article  PubMed  Google Scholar 

  • Menacker F, Hamilton BE.(2010). Recent trends in cesarean delivery in the United States. NCHS Data Brief, (35):1–8.

  • Mi, J., & Liu, F. (2014). Rate of caesarean section is alarming in China. Lancet, 383(9927), 1463–1464. doi:10.1016/S0140-6736(14)60716-9.

    Article  PubMed  Google Scholar 

  • Molina, G., Weiser, T. G., Lipsitz, S. R., et al. (2015). Relationship between cesarean delivery rate and maternal and neonatal mortality. Jama, 314(21), 2263–2270. doi:10.1001/jama.2015.15553.

    Article  CAS  PubMed  Google Scholar 

  • National Collaborating Centre for Women’s and Children’s Health. Caesarean section, 2nd edition. London, UK: Royal College of Obstetricians and Gynaecologists 2011.

    Google Scholar 

  • Powers, J., & Loxton, D. (2010). The impact of attrition in an 11-year prospective longitudinal study of younger women. Annals of epidemiology, 20(4), 318–321. doi:10.1016/j.annepidem.2010.01.002.

    Article  PubMed  Google Scholar 

  • Quigley, M. A., Hockley, C., & Davidson, L. L. (2007). Agreement between hospital records and maternal recall of mode of delivery: evidence from 12 391 deliveries in the UK Millennium Cohort Study. BJOG: An International Journal of Obstetrics and Gynaecology, 114(2), 195–200. doi:10.1111/j.1471-0528.2006.01203.x.

    Article  CAS  Google Scholar 

  • Studdert, D. M., Mello, M. M., Sage, W. M., et al. (2005). Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. Jama, 293(21), 2609–2617. doi:10.1001/jama.293.21.2609.

    Article  CAS  PubMed  Google Scholar 

  • Wax JR, Cartin A, Pinette MG, et al. Patient choice cesarean: an evidence-based review. Obstetrical & gynecological survey. 2004; 59(8):601–16.

    Article  Google Scholar 

  • Witt, W. P., Wisk, L. E., Cheng, E. R., et al. (2015). Determinants of cesarean delivery in the US: A lifecourse approach. Maternal and child health journal, 19(1), 84–93. doi:10.1007/s10995-014-1498-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • World Health Organization (WHO). (2015). BMI classification. Retrieved January 8, 2015, from http://apps.who.int/bmi/index.jsp?introPage=intro_3.html.

  • World Health Organization. (2015) WHO statement on caesarean section rates. Retrieved September 5, 2016, from http://apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf.

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Acknowledgements

The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women’s Health, the University of Newcastle and the University of Queensland. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data.

Author Contributions

AH, JP, CC, and DL made substantial contributions to the conception and design of the study, interpretation of the data and have given approval for the final manuscript. JP conducted the statistical analysis. AH and JP drafted the manuscript.

Funding

The ALSWH is funded by the Australian Government Department of Health. The funding source played no role in the design; in the collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Level 3 Pod, Callaghan, NSW, 2308, Australia

    Alexis Hure, Jennifer Powers, Catherine Chojenta & Deborah Loxton

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  1. Alexis Hure
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  2. Jennifer Powers
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  3. Catherine Chojenta
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  4. Deborah Loxton
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Correspondence to Alexis Hure.

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No conflicts of interest to declare, financial or otherwise.

Ethical Approval

The ALSWH has been granted ethics clearance by the Universities of Newcastle and Queensland (Approvals: H0760795 and 2,004,000,224; 26 July 1995).

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Hure, A., Powers, J., Chojenta, C. et al. Rates and Predictors of Caesarean Section for First and Second Births: A Prospective Cohort of Australian Women. Matern Child Health J 21, 1175–1184 (2017). https://doi.org/10.1007/s10995-016-2216-5

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