THREE ESSAYS ON BIRTHS AFTER CESAREAN SECTION Público
Huang, Ya-Lin Aileen (2010)
Published
Abstract
Abstract
THREE ESSAYS ON BIRTHS AFTER CESAREAN SECTION
By Ya-lin Aileen Huang
The rate of Cesarean section (C-section) delivery in the U.S.
has dramatically
increased over the past decade, resulting in rising hospital costs
in the U.S. This increase in
C-section rate was coupled with an increase in the rate of repeat
C-section and can be largely
attributable to the concerns about the relative safety of vaginal
birth after Cesarean (VBAC).
This dissertation comprises three articles investigating the
practice patterns and
the outcomes of this procedure.
The first chapter investigated how physicians respond
differently to new information
based on the influence of malpractice pressure regarding performing
VBACs. Results show
that higher malpractice pressure may be incentives for physicians
to uptake information and
adopt low-risk practice style.
The second chapter determined whether birth outcomes changed as
a result of
changes in the pattern of birth after C-sections over time.
Selected major maternal and
neonatal adverse events were compared between repeat C-sections and
VBACs. I find
maternal and neonatal outcomes for births after a C-section
significantly improved overtime
along with the secular increase in repeat C-section rates. The
increased adoption of repeat C-
sections may have been driven in part by the observed lower
maternal complication rates
and lower neonatal mortality rates.
The third chapter examined temporal trends in variation in
obstetric practice
patterns focusing on primary and repeat Cesarean sections among
hospitals over time. There
is a statistically significant downward trend in the degree of
cross-hospital variation in repeat
Cesarean section rates, but no similar trend for variation in
primary Cesarean section rates.
Practice patterns for repeat C-section become less variable over
time may be a result of the
diffusion of national clinical guidelines.
THREE ESSAYS ON BIRTHS AFTER CESAREAN SECTION
By
Ya-lin Aileen Huang
B.S., National Taiwan University, 2002
M.S., National Taiwan University, 2004
Advisor: David H. Howard, Ph.D.
A dissertation submitted to the Faculty of the
James T. Laney School of Graduate Studies of Emory University
in partial fulfillment of the requirements for the degree of
Doctor of Philosophy
in Health Services Research and Health Policy
2010
Table of Contents
Table of Contents
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