Determinants of Cesarean Delivery in the US: A Lifecourse Approach

Whitney P. Witt, Lauren E. Wisk, Erika R. Cheng, Kara Mandell, Debanjana Chatterjee, Fathima Wakeel, Amy L. Godecker, Dakota Zarak

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


This study takes a lifecourse approach to understanding the factors contributing to delivery methods in the US by identifying preconception and pregnancy-related determinants of medically indicated and non-medically indicated cesarean section (C-section) deliveries. Data are from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative, population-based survey of women delivering a live baby in 2001 (n = 9,350). Three delivery methods were examined: (1) vaginal delivery (reference); (2) medically indicated C-section; and (3) non-medically indicated C-sections. Using multinomial logistic regression, we examined the role of sociodemographics, health, healthcare, stressful life events, pregnancy complications, and history of C-section on the odds of medically indicated and non-medically indicated C-sections, compared to vaginal delivery. 74.2 % of women had a vaginal delivery, 11.6 % had a non-medically indicated C-section, and 14.2 % had a medically indicated C-section. Multivariable analyses revealed that prior C-section was the strongest predictor of both medically indicated and non-medically indicated C-sections. However, we found salient differences between the risk factors for indicated and non-indicated C-sections. Surgical deliveries continue to occur at a high rate in the US despite evidence that they increase the risk for morbidity and mortality among women and their children. Reducing the number of non-medically indicated C-sections is warranted to lower the short- and long-term risks for deleterious health outcomes for women and their babies across the lifecourse. Healthcare providers should address the risk factors for medically indicated C-sections to optimize low-risk delivery methods and improve the survival, health, and well-being of children and their mothers.

Original languageEnglish (US)
Pages (from-to)84-93
Number of pages10
JournalMaternal and child health journal
Issue number1
StatePublished - Jan 2014
Externally publishedYes

Bibliographical note

Funding Information:
This project was made possible by a Health Resources and Services Administrative (HRSA) (W.P.W., L.E.W., and D.C.: R40MC23625; PI: W.P. Witt) grant. Additional funding for this research was provided by grants from the Agency for Healthcare Research and Quality (K.M. and L.E.W.: T32 HS00083; PI: M. Smith), the Health Disparities Research Scholars Program (F.W.: T32 HD049302; PI: G. Sarto), the 2012–2013 Herman I. Shapiro Distinguished Graduate Fellowship (L.E.W.), and the Science and Medicine Graduate Research Scholars Fellowship from the University of Wisconsin in the College of Agriculture and Life Sciences and the School of Medicine and Public Health (ERC).

Publisher Copyright:
© 2014, Springer Science+Business Media New York.


  • Cesarean section
  • Lifecourse
  • Stressful life events
  • Vaginal delivery


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