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. 2018 Aug;53 Suppl 1(Suppl Suppl 1):2839-2857.
doi: 10.1111/1475-6773.12797. Epub 2017 Nov 12.

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

Ifeoma Muoto  1 , Blair G Darney  2   3 , Bernard Lau  2 , Yvonne W Cheng  4   5 , Mark W Tomlinson  6 , Duncan R Neilson Jr  7 , Steven A Friedman  8 , Joanne Rogovoy  9 , Aaron B Caughey  2 , Jonathan M Snowden  2   10
Affiliations

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

Ifeoma Muoto et al. Health Serv Res. 2018 Aug.

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.

Keywords: Health policy/politics/law/regulation; maternal and perinatal care and outcomes; obstetrics/gynecology.

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Figures

Figure 1
Figure 1
Classification of Cesarean Deliveries
Figure 2
Figure 2
Trends in Early‐Term Cesarean Delivery (2008–2013)
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