Skip to main content

Advertisement

SpringerLink
Log in

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

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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).

Results

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%).

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

CS:

Cesarean section

PFD:

Pelvic floor disorders

WHO:

World Health Organization

References

  1. Statistisches Bundesamt. Krankenhausentbindungen in Deutschland—Jahre 1991–2015. https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Krankenhaeuser/Tabellen/KrankenhausentbindeungenKaiserschnitt.htm. Accessed June 2018

  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. https://doi.org/10.1007/s00404-017-4316-x

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1055/s-0043-120919

    Article  PubMed  PubMed Central  Google Scholar 

  4. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM, Section WHOWGoC (2016) WHO Statement on Caesarean Section Rates. BJOG 123(5):667–670. https://doi.org/10.1111/1471-0528.13526

    Article  CAS  PubMed  Google Scholar 

  5. World Health Organization Human Reproduction Programme A (2015) WHO statement on caesarean section rates. Reprod Health Matters 23(45):149–150. https://doi.org/10.1016/j.rhm.2015.07.007

    Article  Google Scholar 

  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. https://doi.org/10.1136/bmjopen-2017-019120

    Article  PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1016/j.midw.2018.01.009

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1016/j.midw.2018.01.022

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1177/014107680009300703

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1111/j.1467-789X.2008.00537.x

    Article  CAS  PubMed  Google Scholar 

  11. Breart G (1997) Delayed childbearing. Eur J Obstet Gynecol Reprod Biol 75(1):71–73

    Article  CAS  PubMed  Google Scholar 

  12. Sandall J (2015) Place of birth in Europe. Entre Nous The Eur Mag Sexual Reprod Health 81:16–17

    Google Scholar 

  13. Norman JE, Stock SJ (2018) Birth options after a caesarean section. BMJ 360:j5737. https://doi.org/10.1136/bmj.j5737

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1016/j.puhe.2017.10.020

    Article  CAS  PubMed  Google Scholar 

  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. https://doi.org/10.1371/journal.pone.0188074

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1111/aogs.13315

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1111/1471-0528.12075

    Article  CAS  PubMed  Google Scholar 

  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. https://doi.org/10.1001/jama.300.11.1311

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1016/j.ajog.2017.10.014 (e221–222 e219)

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1007/s00192-014-2376-z

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1111/1471-0528.12020

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

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

Funding

There was no funding.

Author information

Authors and Affiliations

  1. Women’s Center Bern, Lindenhofgruppe, Bremgartenstr. 117, 3001, Bern, Switzerland

    Markus Huebner

  2. Department of Womenʼs Health, University Hospital of Tuebingen, Tuebingen, Germany

    Markus Huebner, Harald Abele, Christl Reisenauer, Karl O. Kagan, Markus Hoopmann, Philipp Wagner, Jan Pauluschke-Froehlich, Birgitt Schoenfisch, Sara Y. Brucker & Katharina Rall

Authors
  1. Markus Huebner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harald Abele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christl Reisenauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karl O. Kagan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Markus Hoopmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philipp Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jan Pauluschke-Froehlich
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Birgitt Schoenfisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sara Y. Brucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Katharina Rall
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Markus Huebner.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huebner, M., Abele, H., Reisenauer, C. et al. 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. Arch Gynecol Obstet 299, 747–754 (2019). https://doi.org/10.1007/s00404-019-05073-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-019-05073-4

Keywords

Search

Navigation