Cesarean sections in upstate New York, 1968-1978

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Epidemiology

Background:

• Cesarean section (C-section) use has seen significant shifts over time.
• Understanding trends in C-section rates is crucial for maternal and infant health outcomes.

Purpose of the Study:

• To analyze the changing trends in cesarean section rates between 1968 and 1978 in upstate New York.
• To investigate variations in primary cesarean section use among population subgroups and hospitals.
• To examine the relationship between cesarean section rates, hospital characteristics, and perinatal outcomes.

Main Methods:

• Utilized birth certificate data from upstate New York for the years 1968-1978.
• Analyzed cesarean section percentages across different population subgroups.
• Compared hospital-to-hospital variations in primary cesarean section rates.
• Assessed correlations between cesarean section rates, hospital size, neonatal mortality, and breech delivery percentages.

Main Results:

• The overall percentage of births via cesarean section quadrupled from 1968 to 1978.
• Increases in cesarean section rates varied from 1.5 to 5 times the 1968 levels across population subgroups.
• Hospital variation in primary cesarean section rates increased dramatically from 1968-1969 to 1977-1978.
• Neonatal mortality was linked to cesarean section rates in 1968-1969 but not in 1977-1978.
• An inverse relationship emerged between breech delivery rates and cesarean section rates in 1977-1978.

Conclusions:

• Cesarean section utilization experienced a substantial rise in upstate New York during the study period.
• Significant disparities in cesarean section practices emerged among hospitals.
• The relationship between cesarean section rates and neonatal outcomes evolved over the decade, with breech presentation becoming a key factor.