Special Deliveries

By Karen Hicklin
ISE Ph.D. Student

ISE research team is using decision modeling to keep mothers and babies safe

In 2013, almost one-third of the four million births in the U.S. were cesarean section (C-section) deliveries. Compare that to a 4.5% C-section rate in 1970 and it raises concerns over the methods and preferences of delivery decisions. Based on global maternal mortality rates, the World Health Organization (WHO) suggests that the ideal rate for C-sections should be in the 10 – 15% range. The concern is that C-sections can cause further complications in future pregnancies/births. They also increase the hospital stay of the patient, which takes away from early mother-child bonding.

One of the major reasons for the increasing C-section rate is the drastic decrease in vaginal birth after cesareans (VBAC) in the last 20 years. This fact led ISE professor Julie Ivy and Ph.D. student Karen Hicklin to focus on the reasoning for a woman’s first C-section. So they chose first time mothers who have not elected to have a C-section and who are prime candidates for a vaginal delivery.

The delivery decision is a delicate combination of the mother’s preferences and the expert opinion of the doctor or midwife. The team wanted to understand what factors and risks influence a doctor to end labor and perform a C-section. They asked the question, “How long is too long to wait in labor for a woman who is not expected to reach full dilation?”

Dr. Ivy and Hicklin worked with an obstetrician, patient advocate and doula, health economist and health services researcher. Together they developed different decision models to further understand when it is most appropriate to perform a C-section. One model outlined the trade-off between choosing the correct delivery mode and ensuring the patient’s safety and satisfaction. Another estimated the chance of vaginal delivery versus C-section based on the dilation state of the patient’s cervix.

In one decision model in particular, the results showed that in both lower and higher dilation states, it is more likely that the decision regarding the most appropriate delivery can be made without factoring in labor progression. Yet in middle dilation states, it is best to wait before making the decision of which delivery mode is best. The results showed that more attention should be given to patients who are between 6 cm and 8 cm dilated.

The research has shown that the decision for C-sections is complex. Ensuring a woman’s health during labor as well as the safe delivery of a healthy baby is the overwhelming goal of labor, however, trends show that patient and provider methods and preferences do not always match. The decision models we have developed take this into consideration and provide more insight into their influence on birth. The hope is that this research will influence policy to ensure healthy outcomes for both the mother and child.