Maternal Outcomes Associated With Planned Primary Cesarean Births Compared With Planned Vaginal Births

Declercq, Eugene PhD; Barger, Mary CNM, MPH; Cabral, Howard J. MPH, PhD; Evans, Stephen R. MPH; Kotelchuck, Milton MPH, PhD; Simon, Carol MS, PhD; Weiss, Judith ScD; Heffner, Linda J. MD, PhD

doi: 10.1097/01.AOG.0000255668.20639.40
Original Research

OBJECTIVE: To compare the outcomes and costs associated with primary cesarean births with no labor (planned cesareans) to vaginal and cesarean births with labor (planned vaginal).

METHODS: Analysis was based on a Massachusetts data system linking 470,857 birth certificates, fetal death records, and birth-related hospital discharge records from 1998 and 2003. We examined a subset of 244,088 mothers with no prior cesarean and no documented prenatal risk. We then divided mothers into two groups: those with no labor and a primary cesarean (planned primary cesarean deliveries—3,334 women) and those with labor and either a vaginal birth or a cesarean delivery (planned vaginal—240,754 women). We compared maternal rehospitalization rates and analyzed costs and length of stay.

RESULTS: Rehospitalizations in the first 30 days after giving birth were more likely in planned cesarean (19.2 in 1,000) when compared with planned vaginal births (7.5 in 1,000). After controlling for age, parity, and race or ethnicity, mothers with a planned primary cesarean were 2.3 (95% confidence interval [CI] 1.74–2.9) times more likely to require a rehospitalization in the first 30 days postpartum. The leading causes of rehospitalization after a planned cesarean were wound complications (6.6 in 1,000) (P<.001) and infection (3.3 in 1,000). The average initial hospital cost of a planned primary cesarean of $4,372 (95% C.I. $4,293–4,451) was 76% higher than the average for planned vaginal births of $2,487 (95% C.I. $2,481–2,493), and length of stay was 77% longer (4.3 days to 2.4 days).

CONCLUSION: Clinicians should be aware of the increased risk for maternal rehospitalization after cesarean deliveries to low-risk mothers when counseling women about their choices.

LEVEL OF EVIDENCE: II

A comparison of planned vaginal (which includes unplanned cesareans) with planned primary cesareans finds significantly higher rehospitalization rates and costs associated with planned cesareans.

From the 1 Department of Maternal and Child Health, 2Department of Biostatistics, 3Data Coordinating Center, 4Boston University School of Public Health; Department of Obstetrics and Gynecology, Boston University School of Medicine; and 5Abt Associates, Boston, Massachusetts.

Supported by grants from the Robert Wood Johnson Foundation, grant number 052711 (E. Declercq, principal investigator) and the Centers for Disease Control and Prevention, project number S3485–23/23 (M. Kotelchuck, E. Declercq, M. Barger, H. Cabral, S. Evans, J. Weiss).

Corresponding author: Eugene Declercq, PhD, Professor, Department of Maternal and Child Health, Boston University School of Public Health, 715 Albany Street, Talbot W540, Boston, MA 02118; e-mail: declercq@bu.edu.

© 2007 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.