Can Caesarean section improve child and maternal health? The case of breech babies

Jensen, Vibeke Myrup; Wüst, Miriam

doi:10.1016/j.jhealeco.2014.07.004

Cited by 27 publications

(59 citation statements)

References 45 publications

(50 reference statements)

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“…Nearly 19% of all primary Cesarean deliveries are due to fetal malpresentation [ 2 ], which occurs in approximately 3% of all term deliveries, with breech presentation (bottom/feet down) being the most common form of fetal malpresentation [ 24 ]. Consistent with a large body of evidence documenting inferior health outcomes among malpresenting infants delivered vaginally relative to Cesarean [ 25 – 27 ] and because malpresentation is an indication for Cesarean delivery and thus recommended by the American Congress of Obstetricians and Gynecologists’ (ACOG), [ 28 ] most term malpresenting fetuses are delivered by Cesarean in the U.S. 1…”

Section: Introductionmentioning

confidence: 88%

Cesarean deliveries and maternal weight retention

Kapinos

Yakusheva

Weiss

2017

BMC Pregnancy Childbirth

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BackgroundCesarean delivery accounts for nearly one-third of all births in the U.S. and contributes to an additional $38 billion in healthcare costs each year. Although Cesarean delivery has a long record of improving maternal and neonatal mortality and morbidity, increased utilization over time has yielded public health concerns and calls for reductions. Observational evidence suggests Cesarean delivery is associated with increased maternal postpartum weight, which may have significant implications for the obesity epidemic. Previous literature, however, typically does not address selection biases stemming from correlations of pre-pregnancy weight and reproductive health with Cesarean delivery.MethodsWe used fetal malpresentation as a natural experiment as it predicts Cesarean delivery but is uncorrelated with pre-pregnancy weight or maternal health. We used hospital administrative data (including fields used in vital birth record) from the state of Wisconsin from 2006 to 2013 to create a sample of mothers with at least two births. Using propensity score methods, we compared maternal weight prior to the second pregnancy of mothers who delivered via Cesarean due to fetal malpresentation to mothers who deliver vaginally.ResultsWe found no evidence that Cesarean delivery in the first pregnancy causally leads to greater maternal weight, BMI, or movement to a higher BMI classification prior to the second pregnancy.ConclusionsAfter accounting for correlations between pre-pregnancy weight, gestational weight gain, and mode of delivery, there is no evidence of a causal link between Cesarean delivery and maternal weight retention.

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Section: Introductionmentioning

confidence: 88%

Cesarean deliveries and maternal weight retention

Kapinos

Yakusheva

Weiss

2017

BMC Pregnancy Childbirth

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“…Jensen and Wust focused on health outcomes for infants born just before and just after the arrival of information from a major clinical trial in Denmark, which found that caesarean sections conferred better health outcomes than vaginal delivery for term breech infants. 20 Jensen and Wust showed that caesarean rates increased markedly just after the announcement of the trial results, and that infants born just after the announcement had higher Apgar scores and lower rates of hospital admissions in the first year of life than those born just before the announcement (who were more likely to be delivered vaginally).…”

Section: Clinical Researchmentioning

confidence: 99%

Regression discontinuity designs in healthcare research

Venkataramani

Bor

Jena

2016

BMJ

120

116

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“…Aside from assessing the effect of higher malpractice pressure on C‐sections, we need also to consider consequences for patients' health. Natural deliveries can pose relevant risks when improperly performed: mothers may suffer obstetric trauma, and newborns may suffer severe harm, namely brain damage (Jensen and Wüst, ). Consequently, increasing malpractice pressure could reduce the incidence of C‐sections while increasing the incidence of negative maternal health outcomes.…”

Section: Empirical Analysismentioning

confidence: 99%

Does Experience Rating Improve Obstetric Practices? Evidence from Italy

2015

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Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7-11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream skimming.

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Can Caesarean section improve child and maternal health? The case of breech babies

Cited by 27 publications

References 45 publications

Cesarean deliveries and maternal weight retention

Cesarean deliveries and maternal weight retention

Regression discontinuity designs in healthcare research

Does Experience Rating Improve Obstetric Practices? Evidence from Italy

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