TY - JOUR
T1 - Shifting Patterns in Cesarean Delivery Scheduling and Timing in Oregon before and after a Statewide Hard Stop Policy
AU - Muoto, Ifeoma
AU - Darney, Blair G.
AU - Lau, Bernard
AU - Cheng, Yvonne W.
AU - Tomlinson, Mark W.
AU - Neilson, Duncan R.
AU - Friedman, Steven A.
AU - Rogovoy, Joanne
AU - Caughey, Aaron B.
AU - Snowden, Jonathan M.
N1 - Funding Information:
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under Policy R40 Award (number R40 MC268090201). This information or content and conclusions are those of the author and should not be construed as the official position or policy of nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. Disclaimer: None. Disclosure: None.
Funding Information:
Joint Acknowledgment/Disclosure Statement: JMS is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number R00 HD079658-03).
Funding Information:
Joint Acknowledgment/Disclosure Statement: JMS is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number R00 HD079658-03). This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under Policy R40 Award (number R40 MC268090201). This information or content and conclusions are those of the author and should not be construed as the official position or policy of nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. Disclaimer: None. Disclosure: None.
Publisher Copyright:
© Health Research and Educational Trust
PY - 2018/8
Y1 - 2018/8
N2 - 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.
AB - 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.
KW - Health policy/politics/law/regulation
KW - maternal and perinatal care and outcomes
KW - obstetrics/gynecology
UR - http://www.scopus.com/inward/record.url?scp=85033660506&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85033660506&partnerID=8YFLogxK
U2 - 10.1111/1475-6773.12797
DO - 10.1111/1475-6773.12797
M3 - Article
C2 - 29131330
AN - SCOPUS:85033660506
VL - 53
SP - 2839
EP - 2857
JO - Health Services Research
JF - Health Services Research
SN - 0017-9124
ER -