August 08, 2018

Analysis addresses frequency of cesarean deliveries across U.S. hospitals

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A UAB maternal-fetal specialist led a secondary analysis to determine factors relating to frequency of C-sections across 25 American hospitals.

A secondary analysis of a large national, multicenter study led by a University of Alabama at Birmingham maternal-fetal medicine specialist examined factors that influence the rates of low-risk cesarean deliveries, giving insight into aspects of obstetric care that influence an important quality metric.

According to the analysis of the Assessment of Perinatal Excellence study, author Daniel Pasko, M.D., fellow in UAB’s Division of Maternal-Fetal Medicine, explains that nearly one in three American women will undergo a cesarean delivery. 

“While we know that cesarean delivery is an important and potentially lifesaving intervention,” Pasko said, “cesarean rates vary greatly across providers and hospitals, particularly among low-risk women. This raises questions about potential overuse of the procedure,”

The objective of his secondary analysis was to determine to what extent patient and provider or hospital characteristics influence low-risk cesarean delivery rates.

In the analysis of 25 hospitals across the United States, 38,275 low-risk women were included. The authors examined maternal and fetal characteristics including maternal age, race-ethnicity, insurance status, BMI, hypertensive disorders and size of fetus at birth, among others. Pasko demonstrated that, even though the mothers in the study were considered “low-risk,” they could still have medical complications such as hypertension, which would increase their risk of cesarean delivery. Once accounting, or risk-adjusting, for different patient characteristics, the analysis showed the reason some hospitals had higher cesarean delivery rates was that they took care of women with higher risk characteristics. 

In Alabama, the most recent rate of cesarean delivery was 31 percent among first-time mothers. Comparatively, UAB’s cesarean rate in these low-risk women is 26 percent. “At UAB, our providers, nurses and staff are honored to have the privilege to care for moms and babies from across Alabama, some of whom have significant medical complications,” Pasko said. “Furthermore, we work hard on a daily basis to safely reduce our cesarean delivery rate.” 

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