This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (85)  • Contact me when this article is cited  Related Content  • Related letter  • Related article  • Similar articles in JAMA  Topic Collections  • Pregnancy and Breast Feeding  • Alert me on articles by topic

Mona Lydon-Rochelle, MPH, PhD, CNM; Victoria L. Holt, MPH, PhD; Diane P. Martin, MA, PhD; Thomas R. Easterling, MD

JAMA. 2000;283:2411-2416.

Context  Despite nearly 4 million deliveries in the United States each year, minimal information exists on unintended health consequences following childbirth, particularly in relation to delivery method.

Objective  To assess the risk for maternal rehospitalization associated with cesarean or assisted vaginal delivery compared with spontaneous vaginal delivery.

Design  Retrospective cohort study of data from the Washington State Birth Events Record Database for 1987 through November 1, 1996.

Setting and Participants  All primiparous women without selected chronic medical conditions who delivered live singleton infants in nonfederal short-stay hospitals in Washington State (N=256,795).

Main Outcome Measures  Relative risks (RRs) of rehospitalization within 60 days of cesarean or assisted vaginal vs spontaneous vaginal deliveries.

Results  A total of 3149 women (1.2%) were rehospitalized within 60 days of delivery. In logistic regression analyses adjusting for maternal age, rehospitalization was found to be more likely among women with cesarean delivery (RR, 1.8; 95% confidence interval [CI], 1.6-1.9) or assisted vaginal delivery (RR, 1.3; 95% CI, 1.2-1.4) than among women with spontaneous vaginal delivery. Cesarean delivery was associated with significantly increased risks of rehospitalization for uterine infection, obstetrical surgical wound complications, and cardiopulmonary and thromboembolic conditions. Among women with assisted vaginal delivery, significant increased risks were seen for rehospitalization with postpartum hemorrhage, obstetrical surgical wound complications, and pelvic injury.

Conclusions  Women with cesarean and assisted vaginal deliveries were at increased risk for rehospitalization, particularly with infectious morbidities. Effective strategies for preventing and controlling peripartum infection should be an obstetrical priority.

Author Affiliations: Department of Health Services, School of Public Health and Community Medicine (Drs Lydon-Rochelle and Martin); Department of Family and Child Nursing, School of Nursing (Dr Lydon-Rochelle); Department of Epidemiology, School of Public Health and Community Medicine (Dr Holt); and Department of Obstetrics and Gynecology, School of Medicine (Dr Easterling), University of Washington, Seattle.

RELATED LETTER

Cesarean Delivery and Risk of Herpes Simplex Virus Infection
Dwight J. Rouse and Jeffrey S. A. Stringer
JAMA. 2003;289(17):2208.
EXTRACT | FULL TEXT  

RELATED ARTICLE

May 10, 2000
JAMA. 2000;283(18):2461-2462.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cesarean Delivery as a Barrier for Breastfeeding Initiation: The Puerto Rican Experience
Perez-Rios et al.
J Hum Lact 2008;24:293-302.
ABSTRACT  

Maternal Morbidity Rates in a Managed Care Population
Bruce et al.
Obstet Gynecol 2008;111:1089-1095.
ABSTRACT | FULL TEXT  

Maternal Outcomes Associated With Planned Primary Cesarean Births Compared With Planned Vaginal Births
Declercq et al.
Obstet Gynecol 2007;109:669-677.
ABSTRACT | FULL TEXT  

Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term
Liu et al.
CMAJ 2007;176:455-460.
ABSTRACT | FULL TEXT  

Not safer and not cheaper?
Klein
CMAJ 2006;175:1243-1246.
FULL TEXT  

Postpartum Maternal Mortality and Cesarean Delivery.
Deneux-Tharaux et al.
Obstet Gynecol 2006;108:541-548.
ABSTRACT | FULL TEXT  

Geographic Variation In The Appropriate Use Of Cesarean Delivery
Baicker et al.
Health Aff (Millwood) 2006;25:w355-w367.
ABSTRACT | FULL TEXT  

Maternal Morbidity Associated With Cesarean Delivery Without Labor Compared With Induction of Labor at Term
Allen et al.
Obstet Gynecol 2006;108:286-294.
ABSTRACT | FULL TEXT  

Postpartum Health of Employed Mothers 5 Weeks After Childbirth
McGovern et al.
Ann Fam Med 2006;4:159-167.
ABSTRACT | FULL TEXT  

Coding of Perineal Lacerations and Other Complications of Obstetric Care in Hospital Discharge Data
Romano et al.
Obstet Gynecol 2005;106:717-725.
ABSTRACT | FULL TEXT  

Risk of Maternal Postpartum Readmission Associated With Mode of Delivery
Liu et al.
Obstet Gynecol 2005;105:836-842.
ABSTRACT | FULL TEXT  

Relative Risk of Postpartum Complications in the Ohio Medicaid Population: Vaginal Versus Cesarean Delivery
Koroukian
Med Care Res Rev 2004;61:203-224.
ABSTRACT  

Maternal Morbidity Associated With Cesarean Delivery Without Labor Compared With Spontaneous Onset of Labor at Term
Allen et al.
Obstet Gynecol 2003;102:477-482.
ABSTRACT | FULL TEXT  

Cesarean Delivery and Risk of Herpes Simplex Virus Infection
Cohan
JAMA 2003;289:2208-2208.
FULL TEXT  

Magnitude of Maternal Morbidity During Labor and Delivery: United States, 1993-1997
Danel et al.
Am. J. Public Health 2003;93:631-634.
ABSTRACT | FULL TEXT  

Elective Primary Cesarean Delivery
Minkoff and Chervenak
NEJM 2003;348:946-950.
FULL TEXT  

Mode of Delivery and Risk of Postpartum Rehospitalization
Webb and Robbins
JAMA 2003;289:46-47.
FULL TEXT  

Psychiatric and Substance Use Disorders as Risk Factors for Low Birth Weight and Preterm Delivery
Kelly et al.
Obstet Gynecol 2002;100:297-304.
ABSTRACT | FULL TEXT  

Obstetricians' Opinions Regarding Patient Choice in Cesarean Delivery
Gonen et al.
Obstet Gynecol 2002;99:577-580.
ABSTRACT | FULL TEXT  

Uterine Rupture among Women with a Prior Cesarean Delivery
Heffner et al.
NEJM 2002;346:134-137.
FULL TEXT  

Cesarean Delivery and Postpartum Mortality Among Primiparas in Washington State, 1987-1996
LYDON-ROCHELLE et al.
Obstet Gynecol 2001;97:169-174.
ABSTRACT | FULL TEXT