April 22, 2005
Black women, women aged 35 years or older and women admitted on weekends are more likely to have potentially unnecessary cesarean sections than others, say Tulane University researchers. Their analysis of unnecessary cesarean section deliveries is the first to detail factors correlated with the surgery at the national level.
The results are published in the April issue of Obstetrics & Gynecology. "Reducing the number of unnecessary cesareans is a national health goal because of the potential risk to mothers during delivery and subsequent pregnancies," says senior author Mahmud Khan, professor of health systems management at the Tulane University School of Public Health and Tropical Medicine. "In the USA, we spend more on healthcare than any other country of the world and reducing unnecessary cesareans will help reduce the costs as well. There are multiple factors for both the mother and the physician that could lead to unnecessary cesareans."
Researchers analyzed data on mothers and their deliveries from the 2001 Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database. They considered a cesarean potentially unnecessary if there was no condition mentioned in the patient's record that indicated the need for cesarean surgery.
They also studied repeat cesareans and found that white women were more likely than other mothers to have a second potentially unnecessary cesarean. Overall, the researchers found that 11 percent of mothers had potentially unnecessary first-time cesareans and 65 percent of women with a previous cesarean had a second potentially unnecessary one. Black women had a significantly higher rate of first-time potentially unnecessary cesareans (14 percent) than women of other ethnic groups. Ability to reduce the first time potentially unnecessary cesareans is crucial in lowering the repeat cesareans as well.
Other factors related to a first-time potentially unnecessary cesarean included the mother being older than 35 (12 percent), being admitted on a weekend (12 percent) and living in the Northeast part of the country (12 percent) or in a zip code with a median income under $25,000 per household (12 percent).
Repeat unnecessary cesareans occurred more frequently in white women (66 percent) than other groups. In contrast to women with first-time potentially unnecessary cesarean sections, those who had a repeat procedure were more likely to be admitted on a weekday, be younger than 35 years old, and live in the South or West.
"Women who have had a previous cesarean are often advised to have a second one for health and safety reasons," says co-author Gabriella Pridjian, chair of obstetrics and gynecology at the Tulane University School of Medicine. "Patient choice may also play a role in their decision to have a cesarean that may not be medically indicated."
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