Impact of new labor management guidelines on Cesarean rates among low-risk births at New York City hospitals: A controlled interrupted time series analysis

Ellen Brazier; Luisa N Borrell; Mary Huynh; Elizabeth A Kelly; Denis Nash

doi:10.1016/j.annepidem.2023.01.001

Impact of new labor management guidelines on Cesarean rates among low-risk births at New York City hospitals: A controlled interrupted time series analysis

Ann Epidemiol. 2023 Mar:79:3-9. doi: 10.1016/j.annepidem.2023.01.001. Epub 2023 Jan 5.

Authors

Ellen Brazier¹, Luisa N Borrell², Mary Huynh³, Elizabeth A Kelly⁴, Denis Nash⁵

Affiliations

¹ CUNY Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York, New York, NY; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY. Electronic address: [email protected].
² Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY.
³ Office of Vital Statistics, Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY.
⁴ Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH.
⁵ CUNY Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York, New York, NY; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY.

PMID: 36621618
DOI: 10.1016/j.annepidem.2023.01.001

Abstract

Purpose: To examine the impact of the American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine (ACOG-SMFM) 2014 recommendations for preventing unnecessary primary Cesareans.

Methods: In a population-based cohort of births in New York City from 2012 to 2016, we used controlled interrupted time series analyses to estimate changes in age-standardized Cesarean rates among nulliparous, term, singleton vertex (NTSV) deliveries.

Results: Among 192,405 NTSV births across 40 hospitals, the age-standardized NTSV Cesarean rate decreased after the ACOG-SMFM recommendations from 25.8% to 24.0% (Risk ratio [RR]: 0.93; 95% CI 0.89, 0.97), with no change in the control series. Decreases were observed among non-Hispanic White women (RR: 0.89; 95% CI 0.82, 0.97), but not among non-Hispanic Black women (RR: 0.97; 95% CI 0.88, 1.07), Asian/Pacific Islanders (RR: 1.01; 95% CI 0.91, 1.12), or Hispanic women (RR: 0.94; 95% CI 0.86, 1.02). Similar patterns were observed at teaching hospitals, with no change at nonteaching hospitals.

Conclusions: While low-risk Cesarean rates may be modifiable through changes in labor management, additional research, and interventions to address Cesarean disparities, are needed.

Keywords: Cesarean delivery; Interrupted time series analysis; Labor management; Racial/ethnic disparities.

MeSH terms

Cesarean Section*
Female
Hospitals, Urban
Humans
Interrupted Time Series Analysis
New York City / epidemiology
Parturition*
Pregnancy