Defense Date


Document Type


Degree Name

Master of Public Health


Epidemiology & Community Health

First Advisor

Dr. Elizabeth Turf


Objectives. The purpose of this cross-sectional study was to evaluate whether certain maternal variables were associated with the performance of a primary cesarean delivery rather than a spontaneous vaginal delivery among apparently healthy pregnant women in the Commonwealth of Virginia.Methods. This study utilized the 2004 Virginia Statistics File for Live Births which contained 103,830 records. From this dataset, the following groups of women were excluded: multiparous women, women who had had a previous delivery by any method, women with medical and obstetric problems, women with any labor and delivery complications, women with premature births and women with multiple gestations. The resulting study population only included ostensibly healthy women who had no medical and/or obstetric indication for a primary cesarean delivery. The main outcome variable was the performance of a primary cesarean delivery and the independent variables included maternal race, age, location of residence in the state, educational level, method of payment, birth attendant and number of prenatal visits. Descriptive statistics were first calculated and subsequently univariate and multiple logistic regression analyses were performed to calculate crude and adjusted odds ratios for each variable. Results. The study population included 18,873 live births. The following maternal variables were statistically significantly associated with an increased likelihood of having a primary cesarean section: black race (adjusted odds ratio (OR) 1.58,95% confidence interval (CI) 1.42, 1.76, p-value Conclusions. Specific maternal variables are associated with an increased likelihood of having a primary cesarean section in the absence of an overt medical or obstetric indication (i.e. an elective cesarean section) among women in the Commonwealth of Virginia. These results have important public health implications for patients, obstetric care providers and the healthcare system. Pregnant women need to be fully informed about the risks and benefits of cesarean delivery. Furthermore, ethical issues regarding the provision of elective cesarean sections need to continue to be explored as should the monetary costs of this procedure to our healthcare system.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

June 2008

Included in

Epidemiology Commons