Demographic changes and effects on the mode of delivery: a retrospective analysis of a large birth registry containing 27,729 singleton deliveries in a level I center

  • Markus HuebnerEmail author
  • Harald Abele
  • Christl Reisenauer
  • Karl O. Kagan
  • Markus Hoopmann
  • Philipp Wagner
  • Jan Pauluschke-Froehlich
  • Birgitt Schoenfisch
  • Sara Y. Brucker
  • Katharina Rall
Maternal-Fetal Medicine



To characterize and understand the demographics (age and body mass index, BMI) of a cohort of women who delivered at a single institution over an 11-year period. The purpose of this analysis is to look for effects over time of demographic characteristics on mode of delivery.


Retrospective analysis of singleton deliveries between 2004–2014, n = 27,729; level 1 perinatal center, university hospital setting. Data were extracted from the digital birth registry. All statistical analyses were done using R version 3.5.1. Variables analyzed were: age, BMI, and mode of delivery (in the current and any prior pregnancies).


Mean age increased from 31.1 ± 5.2 years in 2004 to 31.5 ± 5.0 years in 2014 (p < 0.001, eta2 = 0.0006). Mean BMI before pregnancy increased from 23.7 ± 4.5 to 24.7 ± 5.2 kg/m2. Mean BMI at delivery increased from 28.5 ± 4.7 to 29.6 ± 5.2 kg/m2 (p < 0.001, eta2 = 0.0049). Regarding maternal age, patients with elective Cesarean section (CS) (32.5 ± 5.3 years), emergency CS (31.6 ± 5.6 years) and CS in labor (31.4 ± 5.3 years) were older compared to those with spontaneous (31.0 ± 5.2 years) or instrument-assisted vaginal delivery such as vacuum (31.0 ± 5.0 years) and forceps (30.2 ± 5.4 years). Among the multiparous patients, the mode of delivery in prior pregnancies is the variable with the greatest effect on the mode of delivery in any subsequent pregnancies. The mode of delivery was: spontaneous (55.5%), vaginal operative including vacuum and forceps (8.8%), and Cesarean section (35.7%).


Increase of age and BMI over years is significant, but very small and in a range which seems not clinically relevant. Previous births have the strongest effects on mode of delivery in the current pregnancy.


Cesarean Delivery High-risk pregnancy Prolapse Urogynecology 



Body mass index


Cesarean section


Pelvic floor disorders


World Health Organization



The authors acknowledge all participating staff who entered data into the birth registry.

Author contributions

MH: project development, ethical approval, data acquisition, statistical analysis, manuscript writing/editing, project supervision. HA: project development, data acquisition, manuscript writing/editing, project supervision. CR: manuscript writing/editing. KK: project development, manuscript writing/editing. MHO: project development, manuscript writing/editing. PW: manuscript writing/editing. JPF: manuscript writing/editing. BS: statistical analysis, manuscript writing/editing. SYB: project supervision, manuscript writing/editing. KR: project development, statistical analysis, manuscript writing/editing, project supervision.


There was no funding.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest.

Ethical approval

The study was approved by the local ethics committee (Ethics Committee, Department of Medicine, Eberhard Karls University and University Hospital Tuebingen, Germany; 750/2017BO2, 27.11.2017). According to the committee´s guidelines, there is no informed consent of participants required, since this is a retrospective analysis.


  1. 1.
    Statistisches Bundesamt. Krankenhausentbindungen in Deutschland—Jahre 1991–2015. Accessed June 2018
  2. 2.
    Huebner M, Brucker SY, Tunn R, Naumann G, Reisenauer C, Abele H (2017) Intrapartal pelvic floor protection: a pragmatic and interdisciplinary approach between obstetrics and urogynecology. Arch Gynecol Obstet 295(4):795–798. CrossRefGoogle Scholar
  3. 3.
    Bihler J, Tunn R, Reisenauer C, Pauluschke-Frohlich J, Wagner P, Abele H, Rall KK, Naumann G, Wallwiener M, Brucker SY, Hubner M (2017) Personal preference of mode of delivery. What do urogynaecologists choose? Preliminary results of the DECISION Study. Geburtshilfe Frauenheilkd 77(11):1182–1188. CrossRefGoogle Scholar
  4. 4.
    Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM, Section WHOWGoC (2016) WHO Statement on Caesarean Section Rates. BJOG 123(5):667–670. CrossRefGoogle Scholar
  5. 5.
    World Health Organization Human Reproduction Programme A (2015) WHO statement on caesarean section rates. Reprod Health Matters 23(45):149–150. CrossRefGoogle Scholar
  6. 6.
    Wehberg S, Guldberg R, Gradel KO, Kesmodel US, Munk L, Andersson CB, Jolving LR, Nielsen J, Norgard BM (2018) Risk factors and between-hospital variation of caesarean section in Denmark: a cohort study. BMJ Open 8(2):e019120. CrossRefGoogle Scholar
  7. 7.
    Fahmy WM, Crispim CA, Cliffe S (2018) Association between maternal death and cesarean section in Latin America: a systematic literature review. Midwifery 59:88–93. CrossRefGoogle Scholar
  8. 8.
    Bermudez-Tamayo C, Johri M, Chaillet N (2018) Budget impact of a program for safely reducing caesarean sections in Canada. Midwifery 60:20–26. CrossRefGoogle Scholar
  9. 9.
    Lucas DN, Yentis SM, Kinsella SM, Holdcroft A, May AE, Wee M, Robinson PN (2000) Urgency of caesarean section: a new classification. J R Soc Med 93(7):346–350. CrossRefGoogle Scholar
  10. 10.
    Poobalan AS, Aucott LS, Gurung T, Smith WC, Bhattacharya S (2009) Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women—systematic review and meta-analysis of cohort studies. Obes Rev 10(1):28–35. CrossRefGoogle Scholar
  11. 11.
    Breart G (1997) Delayed childbearing. Eur J Obstet Gynecol Reprod Biol 75(1):71–73CrossRefGoogle Scholar
  12. 12.
    Sandall J (2015) Place of birth in Europe. Entre Nous The Eur Mag Sexual Reprod Health 81:16–17Google Scholar
  13. 13.
    Norman JE, Stock SJ (2018) Birth options after a caesarean section. BMJ 360:j5737. CrossRefGoogle Scholar
  14. 14.
    Castiglioni L, Schmiedeberg C (2018) Joint effect of education and age at childbirth on the risk of caesarean delivery: findings from Germany 2008–2015. Public Health 155:1–7. CrossRefGoogle Scholar
  15. 15.
    Begum T, Rahman A, Nababan H, Hoque DME, Khan AF, Ali T, Anwar I (2017) Indications and determinants of caesarean section delivery: evidence from a population-based study in Matlab, Bangladesh. PLoS ONE 12(11):e0188074. CrossRefGoogle Scholar
  16. 16.
    Caudwell-Hall J, Kamisan Atan I, Brown C, Guzman Rojas R, Langer S, Shek KL, Dietz HP (2018) Can pelvic floor trauma be predicted antenatally? Acta Obstet Gynecol Scand. Google Scholar
  17. 17.
    Glazener C, Elders A, Macarthur C, Lancashire RJ, Herbison P, Hagen S, Dean N, Bain C, Toozs-Hobson P, Richardson K, McDonald A, McPherson G, Wilson D, ProLong Study G (2013) Childbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse. BJOG 120(2):161–168. CrossRefGoogle Scholar
  18. 18.
    Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, Whitehead WE, Wu J, Brody DJ, Pelvic Floor Disorders N (2008) Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300(11):1311–1316. CrossRefGoogle Scholar
  19. 19.
    Jelovsek JE, Chagin K, Gyhagen M, Hagen S, Wilson D, Kattan MW, Elders A, Barber MD, Areskoug B, MacArthur C, Milsom I (2018) Predicting risk of pelvic floor disorders 12 and 20 years after delivery. Am J Obstet Gynecol 218(2):222. (e221–222 e219) CrossRefGoogle Scholar
  20. 20.
    Wilson D, Dornan J, Milsom I, Freeman R (2014) UR-CHOICE: can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction? Int Urogynecol J 25(11):1449–1452. CrossRefGoogle Scholar
  21. 21.
    Gyhagen M, Bullarbo M, Nielsen TF, Milsom I (2013) Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG 120(2):152–160. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Markus Huebner
    • 1
    • 2
    Email author
  • Harald Abele
    • 2
  • Christl Reisenauer
    • 2
  • Karl O. Kagan
    • 2
  • Markus Hoopmann
    • 2
  • Philipp Wagner
    • 2
  • Jan Pauluschke-Froehlich
    • 2
  • Birgitt Schoenfisch
    • 2
  • Sara Y. Brucker
    • 2
  • Katharina Rall
    • 2
  1. 1.Women’s Center Bern, LindenhofgruppeBernSwitzerland
  2. 2.Department of Womenʼs HealthUniversity Hospital of TuebingenTuebingenGermany

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