Shifting Patterns in Cesarean Delivery Scheduling and Timing in Oregon before and after a Statewide Hard Stop Policy

• Published in: Health services research Vol. 53; no. 4; pp. 2839 - 2857
• Main Authors: Muoto, Ifeoma, Darney, Blair G., Lau, Bernard, Cheng, Yvonne W., Tomlinson, Mark W., Neilson, Duncan R., Friedman, Steven A., Rogovoy, Joanne, Caughey, Aaron B., Snowden, Jonathan M.
• Format: Journal Article
• Language: English
• Published: United States Health Research and Educational Trust 01.08.2018; Blackwell Publishing Ltd; John Wiley and Sons Inc
• Subjects: Analysis; Births; Categories; Cesarean section; Cohort analysis; Confidence intervals; Constraining; Data collection; Data processing; Delivery scheduling; Extraction; Health Policy Impacts; Health policy/politics/law/regulation; Health risk assessment; Infants (Newborn); Intensive care; maternal and perinatal care and outcomes; Morbidity; Multivariable control; Neonatal units; Neonates; Newborn infants; obstetrics/gynecology; Prevalence studies (Epidemiology); Regression analysis; Regression models; Statistical analysis; Statistical methods; Statistics; Time series; Timing; Trends; Ventilation; Vital statistics; Women; Oregon; United States > US; Health policy/politics/law/regulation; maternal and perinatal care and outcomes; obstetrics/gynecology
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.12797

Objectives To assess the use and timing of scheduled cesareans and other categories of cesarean delivery and the prevalence of neonatal morbidity among cesareans in Oregon before and after the implementation of Oregon's statewide policy limiting elective early deliveries. Data Sources Oregon vital statistics records, 2008–2013. Study Design Retrospective cohort study, with multivariable logistic regression, regression controlling for time trends, and interrupted time series analyses, to compare the odds of different categories of cesarean delivery and the odds of neonatal morbidity pre‐ and postpolicy. Data Collection/Extraction Methods We analyzed vital statistics data on all term births in Oregon (2008–2013), excluding births in 2011. Principal Findings The odds of early‐term scheduled cesareans decreased postpolicy (adjusted odds ratio [aOR], 0.70; 95 percent confidence interval [CI], 0.66–0.74). In the postpolicy period, there were mixed findings regarding assisted neonatal ventilation and neonatal intensive care unit admission, with regression models indicating higher postpolicy odds in some categories, but lower postpolicy odds after controlling for time trends. Conclusions Oregon's hard stop policy limiting elective early‐term cesarean delivery was associated with lower odds of cesarean delivery in the category of women who were targeted by the policy; more research is needed on impact of such policies on neonatal outcomes.