How Much is too Much? High Utilization of Prenatal Care and Its Impact on Primary Cesarean Birth Among Women in the United States

IntroductionNationally, cesarean birth is one of the most performed surgical procedures, yet cesarean births have been linked to an increased risk of delivery complications. Prenatal care (PNC) and education are possible strategies to reduce the number of cesarean births. However, there is scant research assessing the impact of these strategies on safely reducing primary cesarean births. This study evaluates the association between the adequacy of PNC utilization and primary cesarean birth.MethodsThe analysis used 2018 birth certificate data, and the sample included nulliparous women with no reported pregnancy or delivery complications (N = 729,140). Logistic regression was used to model the association between the adequacy of PNC utilization and delivery method, as well as identify other factors associated with the delivery method.ResultsAmong women with a primary cesarean birth, 36.2% had received adequate plus PNC. After adjustment, there was no significant association between women receiving inadequate, intermediate, or adequate PNC and primary cesarean birth. However, women who received adequate plus PNC had an increased odds of having a primary cesarean birth compared to women with no PNC (OR, 1.23; 95% CI, 1.18-1.28).DiscussionFindings from this study highlight the need to further understand the role of PNC and its potential impact on the delivery method. Within the patient-provider relationship, healthcare providers have the unique opportunity to provide education and inform patients of the risks and benefits of all delivery options. Thus, there is an increased opportunity to safely reduce primary cesarean births. In the United States, cesarean births remain relatively high and are associated with potentially adverse effects. However, literature describing the potential impact of strategies to reduce cesarean births, such as prenatal care, and its association with the delivery method is lacking. Using 2018 birth certificate data, researchers were able to evaluate the adequacy of prenatal care utilization and primary cesarean birth association. This study found that women with a high utilization of prenatal care were more likely to have a primary cesarean birth; therefore, healthcare providers are essential in advising pregnant women about the risks and benefits of primary cesarean birth.