Abstract
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.
| Original language | English (US) |
|---|---|
| Journal | Health Services Research |
| DOIs | |
| State | Accepted/In press - 2017 |
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Keywords
- Health policy/politics/law/regulation
- Maternal and perinatal care and outcomes
- Obstetrics/gynecology
ASJC Scopus subject areas
- Health Policy
Cite this
Shifting Patterns in Cesarean Delivery Scheduling and Timing in Oregon before and after a Statewide Hard Stop Policy. / Muoto, Ifeoma; Darney, Blair; Lau, Bernard; Cheng, Yvonne W.; Tomlinson, Mark W.; Neilson, Duncan R.; Friedman, Steven A.; Rogovoy, Joanne; Caughey, Aaron; Snowden, Jonathan.
In: Health Services Research, 2017.Research output: Contribution to journal › Article
}
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
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
AU - Snowden, Jonathan
PY - 2017
Y1 - 2017
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
JO - Health Services Research
JF - Health Services Research
SN - 0017-9124
ER -