Risk Factors for Cesarean Section in a Predominantly Cherokee Population in Rural Oklahoma Open Access

Abstract

Objective : With evidence to indicate that the American Indian population is not a homogenous group, the objective of this study is to identify and describe the prevalence of risk factors for cesarean section among a predominantly Cherokee population in order to decrease the cesarean section rate. Methods: The study is a retrospective review of 809 consecutive deliveries in 2011 at Cherokee Nation Hastings Hospital in northeastern Oklahoma. Data were analyzed to describe the incidence of cesarean section, diabetes, hypertension, body mass index at delivery, pre-pregnancy body mass index, induction of labor, and ethnicity. Odds ratios were calculated for cesarean section and birth weight greater than 4000 grams using diabetes, hypertension, Cherokee descent, obesity at delivery, morbid obesity at delivery, induction, and gestational age. Results: The results showed comparable rates of diabetes and obesity in relation to population data on American Indians. Rates of induction of labor and cesarean section were higher than the national average. The strongest predictors for cesarean section were morbid obesity at delivery, hypertension and obesity at delivery. The strongest predictors for birth weight greater than 4000 grams were gestational age of 40+ weeks, diabetes, and morbid obesity at delivery. Conclusion: Maternal characteristics do not distinguish this patient population served by Hastings Hospital from population data on US American Indians. Decreasing the cesarean section rate will require a combined approach of sustained public health measures to address pre-conception health and clinical interventions during prenatal care.

Table of Contents

Contents

Abbreviations

Acknowledgments

Introduction

Contextual Considerations

Literature Review

Obesity

Induction of Labor

Diabetes

Data on American Indians

Summary and Conclusions of the Literature.

Design and Methodology

Data Collection, Analysis, and Results

Data Collection

Analysis

Results

Descriptive analysis of the cohorts

Odds ratios for selected predictors

Discussion

References

Appendix 1 - Journal Article

Appendix 2 - SAS Code

Comparative analysis of cohort 1 and 2

Regression analysis of cohort 2

Appendix 3 - Tribes represented in the sample

About this Master's Thesis

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology
Keyword	Cesarean Section American Indian Cherokee
Committee Chair / Thesis Advisor	Becker, Edmund R, Emory University
Committee Members	McCarthy, Brian,
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti)

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