Maternal and Child Health Journal

, Volume 14, Issue 2, pp 147–154 | Cite as

Neonatal Mortality Risk for Repeat Cesarean Compared to Vaginal Birth after Cesarean (VBAC) Deliveries in the United States, 1998–2002 Birth Cohorts

  • Fay Menacker
  • Marian F. MacDorman
  • Eugene Declercq
Article

Abstract

To examine trends in repeat cesarean delivery, the characteristics of women who have repeat cesareans, and the risk of neonatal mortality for repeat cesarean birth compared to vaginal birth after cesarean (VBAC). Trends and characteristics of repeat cesareans were examined for: the period 1998–2002 for [1] all births, [2] low-risk births (singleton, term, vertex births) and [3] “no indicated risk” (NIR) births (singleton, term, vertex presentation births with no reported medical risks or complications). For low-risk and NIR births, neonatal mortality rates for repeat cesareans and VBACs were compared. Multivariate logistic regression was used to examine the risk of neonatal mortality for repeat cesareans and VBACs, after controlling for demographic and health factors. In 2002 the repeat cesarean rate was 87.4%, and varied little by maternal risk status or by demographic and health characteristics. From 1998–2002 rates increased by 20% for low risk and by 21% for NIR births, respectively. For low-risk women for the 1998–2002 birth cohorts, the adjusted odds ratio for neonatal mortality associated with repeat cesarean delivery (compared with VBAC) was 1.36 (95% C.I. 1.20–1.55). For NIR women, the adjusted odds ratio was 1.24 (0.99–1.55). The experience of a prior cesarean has apparently become a major indication for a repeat cesarean. Regardless of maternal risk status, almost 90% of women with a prior cesarean have a subsequent (i.e., repeat) cesarean delivery. This is the case even if there was no other reported medical indication. Our findings do not support the widely-held belief that neonatal mortality risk is significantly lower for repeat cesarean compared to VBAC delivery.

Keywords

Cesarean delivery Repeat cesarean delivery Vaginal birth after cesarean (VBAC) Neonatal mortality Low-risk births 

References

  1. 1.
    Martin, J. A., Hamilton, B. E., Sutton, P. D., et al. (2006). Births Final data for 2004. National vital statistics reports, vol 55 no 1. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  2. 2.
    Sachs, B. P., Kobelin, C., Castro, M. A., & Frigoletto, F. (1999). The risks of lowering the cesarean delivery rate. New England Journal of Medicine, 340, 54–57.CrossRefPubMedGoogle Scholar
  3. 3.
    McMahon, M. J., Luther, E. R., Bowes, W. A., & Olshan, A. F. (1996). Comparison of a trial of labor with an elective second cesarean section. New England Journal of Medicine, 335, 689–695.CrossRefPubMedGoogle Scholar
  4. 4.
    Mozurkewich, E. L., & Hutton, E. K. (2000). Elective repeat cesarean delivery versus trial of labor: A meta-analysis of the literature from 1989 to 1999. American Journal of Obstetrics and Gynecology, 183, 1187–1197.CrossRefPubMedGoogle Scholar
  5. 5.
    American College of Obstetricians and Gynecologists. (1999). Vaginal birth after previous cesarean delivery. Washington, DC: ACOG.Google Scholar
  6. 6.
    Lydon-Rochelle, M., Holt, V., Easterling, T., & Martin, D. (2001). Risk of uterine rupture during labor among women with a prior cesarean delivery. New England Journal of Medicine, 345, 3–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Greene, M. (2001). Vaginal delivery after Cesarean Section- is the risk acceptable? New England Journal of Medicine, 345, 55.CrossRefGoogle Scholar
  8. 8.
    American College of Obstetricians and Gynecologists. (2000). Task force on cesarean delivery. Evaluation of cesarean delivery. ACOG guidelines. Washington, DC: American College of Obstetricians and Gynecologists (ACOG).Google Scholar
  9. 9.
    Declercq, E. R., Menacker, F., & MacDorman, M. F. (2005). The rise in “no indicated risk” primary caesareans in the US, 1991–2001. British Medical Journal, 330, 71–72.CrossRefPubMedGoogle Scholar
  10. 10.
    SAS Institute Inc. (2006). Base SAS 9.1.3. Cary, N.C: SAS Institute Inc.Google Scholar
  11. 11.
    Wennberg, J. E. (2002). Unwarranted variations in healthcare delivery: implications for academic medical centres. British Medical Journal, 325, 961–964.CrossRefPubMedGoogle Scholar
  12. 12.
    Balcker, K., Buckles, K. S., & Chandra, A. (2006). Geographic variation in the appropriate use of cesarean delivery. Health Affairs, Web Exclusive, 255, w355–367.CrossRefGoogle Scholar
  13. 13.
    Greene. S. B., Holmes, G. M., Slifkin, R., et al. (2005). Cesarean section rates in rural hospitals. Findings Brief, Health Resources and Services Administration (HRSA), http://www.ask.hrsa.gov/detail_materials.cfm?ProdID=3518. Accessed 11/10/09.
  14. 14.
    Martin, J. A., Hamilton, B. E., Sutton, P. D., et al. (2002). Births: Final data for 2007: National vital statistics reports; vol 52 no 10. Hyattsville, Maryland: National Center for Health Statistics.Google Scholar
  15. 15.
    Zweifler, J., Garza, A., Hughes, S., et al. (2006). Vaginal birth after cesarean in California before and after a change in guidelines. Ann Fam Med, 4(3), 228–234.CrossRefPubMedGoogle Scholar
  16. 16.
    Rybak, E. A. (2009). Hippocratic ideal, Faustian bargain and Damocles sword: Erosion of patient autonomy in obstetrics. Journal of Perinatology, 29(11), 721–725.CrossRefPubMedGoogle Scholar
  17. 17.
    American College of Obstetricians and Gynecologists. (2004). Practice bulletin: Vaginal birth after previous cesarean delivery. Obstetrics and Gynecology, 104, 203–211.Google Scholar
  18. 18.
    Stolberg, S. G. (2001). A risk is found in natural birth after cesarean. New York Times. July 5, p. 1.Google Scholar
  19. 19.
    MacDorman, M. F., Declercq, E., Menacker, F., & Malloy, M. H. (2006). Infant and neonatal mortality for primary cesarean and vaginal births to women with “no indicated risk”, United States, 1998–2001 birth cohorts. Birth, 333, 175–182.CrossRefGoogle Scholar
  20. 20.
    Flamm, B. L. (1997). Once a cesarean, always a controversy. Obstetrics and Gynecology, 902, 312–315.CrossRefGoogle Scholar
  21. 21.
    Guise, J.-M., McDonagh, M., Hashima, J., et al. (2003). Vaginal births after cesarean VBAC. Evidence report/technology assessment no. 71 prepared by the Oregon Health & Science University Evidence-based Practice Center under contract no. 209-977-0018. AHRQ Publication No. 03-Eoi8. Agency for Healthcare Research and Quality, Rockville, MD.Google Scholar
  22. 22.
    Lyerly, A. D., Mitchell, L. M., Armstrong, E. M., Harris, L. H., Kukla, R., Kuppermann, M., et al. (2007). Risks, values, and decision making surrounding pregnancy. Obstetrics and Gynecology, 109(4), 979–984.PubMedGoogle Scholar
  23. 23.
    Yang, Q., Wen, S. W., & Oppenheimer, L. (2007). Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy. BJOG, 114, 609–613.CrossRefPubMedGoogle Scholar
  24. 24.
    Silver, M., Landon, M. B., Rouse, S. J., et al. (2006). Maternal morbidity associated with multiple repeat cesarean deliveries. Obstetrics and Gynecology, 107(6), 1226–1232.PubMedGoogle Scholar
  25. 25.
    Landon, M. B., Hauth, J. C., Leveno, K. J., et al. (2004). Maternal and perinatal outcomes associated with trial of labor after prior cesarean delivery. NEJM, 351(25), 2581–2589.CrossRefPubMedGoogle Scholar
  26. 26.
    Dodd, J., & Crowther, C. (2004). Vaginal birth after cesarean versus elective repeat cesarean for women with a single prior cesarean birth. Australian and New Zealand Journal of Obstetrics and Gynecology, 44, 387–391.CrossRefGoogle Scholar
  27. 27.
    Lavender, T., Hofmeyr, G. J., Neilson, J. P., et al. (2009). Cesarean section for non-medical reasons at term. Cochrane database of systematic reviews, 2006. Issue 3 Art No.: CD004660. doi: 10.1002/14651858. CD004660.pub2. Accessed November 10.
  28. 28.
    Kamath, B. D., Todd, J. K., Lezotte, D., et al. (2009). Neonatal outcomes after elective cesarean delivery. Obstetrics and Gynecology, 113(6), 1231–1238.PubMedGoogle Scholar
  29. 29.
    Kotas, T., Saugstad, O. D., Daltveit, A., et al. (2006). Planned cesarean versus planned vaginal delivery at term: Comparison of newborn infant outcomes. Obstetrics and Gynecology, 195, 1538–1593.Google Scholar
  30. 30.
    DiGiuseppe, D. L., Aron, D. C., Ranbom, L., et al. (2002). Reliability of birth certificate data: A multi-hospital comparison to medical records information. Maternal and Child Health Journal, 6(3), 169–179.CrossRefPubMedGoogle Scholar
  31. 31.
    Roohan, P. J., Josberger, R. E., Acar, J., et al. (2003). Validation of birth certificate data in New York state. Journal of Community Health, 28, 335–346.CrossRefPubMedGoogle Scholar
  32. 32.
    Lydon-Rochelle, M. T., Holt, V. L., Cardenas, V., et al. (2005). The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. American Journal of Obstetrics and Gynecology, 193, 125–134.CrossRefPubMedGoogle Scholar
  33. 33.
    Kozak, L. J., Lees, K. A., & DeFrances, C. J. (2006). National hospital discharge survey. 2003 annual summary with detailed diagnosis and procedure data. National Center for Health Statistics. Vital & Health Statistics, 160, 1–206.Google Scholar
  34. 34.
    Menacker, F., & Martin, J. A. (2008). Expanded health data from the new birth certificate, 2005. National vital statistics reports; vol 56, no. 13. Hyattsville, MD. National Center for Health Statistics.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Fay Menacker
    • 1
  • Marian F. MacDorman
    • 2
  • Eugene Declercq
    • 3
  1. 1.Division of Vital StatisticsNational Center for Health Statistics, Centers for Disease Control and PreventionHyattsvilleUSA
  2. 2.Division of Vital StatisticsNational Center for Health Statistics, Centers for Disease Control and PreventionHyattsvilleUSA
  3. 3.Maternal and Child Health DepartmentBoston University School of Public HealthBostonUSA

Personalised recommendations