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Archives of Gynecology and Obstetrics

, Volume 271, Issue 4, pp 338–342 | Cite as

Occupation and risk of cesarean section: study based on the perinatal survey of Baden-Württemberg, Germany

  • Elisabeth Simoes
  • Siegfried Kunz
  • Margarete Bosing-Schwenkglenks
  • Friedrich-Wilhelm Schmahl
Original Article

Abstract

Objectives

The aim of this study was to assess the current influence of educational attainment and occupation on maternal obstetrical risk associated with cesarean section under the conditions of an industrialized country and provision of universal coverage.

Materials and methods

The perinatal survey data 1998–2001 of the German state of Baden-Württemberg were studied comparing method of delivery for the different occupational categories raised in the survey and the influence of antenatal care utilization. For statistical analysis chi square test, Fisher’s exact test and chi square test for trends were used. Relative risks describe the risk for the exposed.

Results

Cesarean section rate increased for all groups over the studied four years period. High rates of surgical deliveries were found for the categories “high salaried position” and “unskilled workers”. Housewives, the largest group of pregnant women in Baden-Württemberg, delivered significantly less often by cesarean section (75% vaginal deliveries) than women of all other groups (66% vaginal deliveries on the average). In case of low utilization of antenatal care (<5 checks) risk of cesarean section and rate of complications (as blood loss >1,000 ml, hysterectomy) associated with cesarean section are significantly higher.

Conclusions

Differences in an individual woman’s risk of having a cesarean section is, besides many other factors, associated with occupation. Antenatal care promotion should target the collective of unskilled workers, at special risk for insufficient use of prenatal care and high rate of cesarean delivery.

Keywords

Perinatal survey data Cesarean delivery Occupation Prenatal care 

Notes

Acknowledgements

The authors gratefully acknowledge the support of the other members of the Perinatal Working Group Baden-Württemberg: Prof. Dr. med. Mickan, deputee of the Medical Doctors’ Chamber (Ärztekammer) Baden-Württemberg, Dr. med. Staudt-Grauer, deputee of the Medical Service of the Statutory Health Insurance (MDK) Baden-Württemberg, Prof. Dr. med. Simon und Dr. med. Roll, deputies of the Hospital Society Baden-Württemberg (Baden-Württembergische Krankenhausgesellschaft). We would like to thank Mrs. Hübsch and Mrs. Häderle, GeQiK, for assistance and support in statistics. No additional funding or support was necessary for this study.

References

  1. 1.
    Adler NE, Newmann K (2002) Socioeconomic disparities in health—pathways and policies. Health Affairs 21:60–76PubMedGoogle Scholar
  2. 2.
    Association of Maryland Hospitals and Health Systems (2003) Maryland Hospital Association Quality Indicator Project. List of performance measures. http://www.qiproject.org/TargetQuality/TQ1297.asp#Wiscosin
  3. 3.
    Beguin F (1996) Surveillance de la grossesse dans le cadre de la nouvelle LAMal. Arch Gynecol Obstet 259 [Suppl]:84–87Google Scholar
  4. 4.
    Bundesgeschäftsstelle für Qualitätssicherung (2003) http://www.bqs-online.de
  5. 5.
    Chandrashekar S, Rao RS, Nair ND, Kutty PR (1998) Socio-demographic determinants of antenatal care. Trop Doct 28:206–209PubMedGoogle Scholar
  6. 6.
    Erata YE, Kilic B, Güclü S, Saygili U, Uslu T (2002) Risk factors for pelvic surgery. Arch Gynecol Obstet 267:14–18PubMedGoogle Scholar
  7. 7.
    Gissler M, Meriläinen J, Vuori E, Hemminki E (2002) Register based monitoring shows decreasing socioeconomic differences in Finnish perinatal health. Eur J Public Health 12 [Suppl]:57Google Scholar
  8. 8.
    Greenberg RS (1983) The impact of prenatal care in different social groups. Am J Obstet Gynecol 145:797–801PubMedGoogle Scholar
  9. 9.
    Hung S, Morrison DR, Whittingtion LA, Beck Fein S (2002) Prepartum work, job characteristics, and risk of cesarean delivery. Birth 29:10–16PubMedGoogle Scholar
  10. 10.
    Marcoux S, Bérubé S, Brisson C, Mondor M (1999) Job strain and pregnancy-induced hypertension. Epidemiology 10:376–382PubMedGoogle Scholar
  11. 11.
    Minkoff H, Chervenak FA (2003) Elective primary cesarean delivery. N Engl J Med 348:946–950PubMedGoogle Scholar
  12. 12.
    National Health Service (NHS), Department of Health (2002) NHS Performance indicators: February 2002.http://www.doh.gov.uk/nhsperformanceindicators/2002/index.html
  13. 13.
    Paterson-Brown S (1998) Should doctors perform an elective caesarean section on request? BMJ 317:462–463PubMedGoogle Scholar
  14. 14.
    Pinhas-Hamiel O, Rotstein Z, Achiron A, Gabbay U, Achiron R, Barak Y, Israeli A (1999) Pregnancy during residency—an Israeli survey of women physicians. Health Care Women Int 20:63–70PubMedGoogle Scholar
  15. 15.
    Rath W, Vetter K (2002) Der Kaiserschnitt zwischen Selbstbestimmungsrecht der Schwangeren, Mangel an gesichertem Wissen und ärztlicher Entscheidung. Geburtshilfe Frauenheilk 62:838–842CrossRefGoogle Scholar
  16. 16.
    Ross CE, Wu C (1995) The links between education and health. Am Soc Rev 10:719–745Google Scholar
  17. 17.
    Simoes E, Kunz S, Bosing-Schwenkglenks M, Schwoerer P, Schmahl FW (2003) Inanspruchnahme der Schwangerenvorsorge—ein Spiegel gesellschaftlicher Entwicklungen und Aspekte der Effizienz. Geburtshilfe Frauenheilkd 63:529–537CrossRefGoogle Scholar
  18. 18.
    Trujillo-Hernández B, Rios-Silva M, Huerta M, Trujillo X, Vásquez C, Millán-Guerrero R (2002) Frequency of, indications for and clinical epidemiological characteristics of first time cesarean section, compared with repeated cesarean section. Arch Gynecol Obstet 267:27–32PubMedGoogle Scholar
  19. 19.
    Tussing AD, Wojtowyez M (1992) The cesarean decision in New York State 1986: economic and noneconomic aspects. Med Care 30:520–540Google Scholar
  20. 20.
    Villar J, Baáqeel H, Piaggio G, Lumbiganon P, Miguel Belizan J, Farnot U, Al-Mazrou Y, Carroli G, Pinol A, Donner A, Langer A, Nigenda G, Mugford M, Fox-Rushby J, Hutton G, Bergsjo P, Bakketeig L, Berendes H, Garcia J, WHO Antenatal Care Trial Research Group (2001) WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet 357:1551–1564PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Elisabeth Simoes
    • 1
  • Siegfried Kunz
    • 2
  • Margarete Bosing-Schwenkglenks
    • 3
  • Friedrich-Wilhelm Schmahl
    • 4
  1. 1.Competence Center of Quality Assurance and Quality Management (KCQ)c/o Medical Service of the Statutory Health Insurance (MDK) Baden-WürttembergLahrGermany
  2. 2.Clinic of Gynecology and ObstetricsClinic am SteinenbergReutlingenGermany
  3. 3.Office of Quality Assurance in Hospitals (GeQiK)c/o Hospital Society of Baden-Württemberg e.VStuttgartGermany
  4. 4.Department of Occupational and Social MedicineUniversity of TübingenTübingenGermany

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