Trends in Indigenous and non-Indigenous caesarean section births in the Northern Territory of Australia, 1986-2012: a total population-based study

Thompson, F., Dempsey, K. and Mishra, G. (2016) Trends in Indigenous and non-Indigenous caesarean section births in the Northern Territory of Australia, 1986-2012: a total population-based study. BJOG: An International Journal of Obstetrics and Gynaecology, 123 11: 1814-1823. doi:10.1111/1471-0528.13881


Author Thompson, F.
Dempsey, K.
Mishra, G.
Title Trends in Indigenous and non-Indigenous caesarean section births in the Northern Territory of Australia, 1986-2012: a total population-based study
Journal name BJOG: An International Journal of Obstetrics and Gynaecology   Check publisher's open access policy
ISSN 1471-0528
1470-0328
Publication date 2016-01-18
Year available 2016
Sub-type Article (original research)
DOI 10.1111/1471-0528.13881
Open Access Status Not Open Access
Volume 123
Issue 11
Start page 1814
End page 1823
Total pages 10
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Subject 2729 Obstetrics and Gynaecology
Abstract Objective: To examine trends in caesarean section deliveries and factors associated with these trends for Indigenous and non-Indigenous mothers. Design: Total population-based study. Setting: Northern Territory of Australia, 1986–2012. Population: Pregnancies among Northern Territory residents, limited to singleton live births with cephalic presentations delivered at 37–42 weeks’ gestation (n = 78 561). Methods: Descriptive analyses of demographic and obstetric risk factors. Poisson regression with robust variance to estimate the likelihood of caesarean delivery with and without labour compared with vaginal delivery, over time and between Indigenous and non-Indigenous mothers, adjusting for risk factors. Main outcome measures: Trends in caesarean sections and risk of caesarean delivery compared with vaginal delivery. Results: The total rate of caesarean deliveries in the Northern Territory increased between 1986 and 2012. From the year 2000, the rise was driven by increases in caesareans with labour among nulliparous mothers and no labour caesareans among multiparous mothers. Increases in demographic and obstetric risk factors explained the rise in caesareans with labour among nulliparous Indigenous mothers, whereas other unmeasured variables contributed to the rise among non-Indigenous mothers. Increases in previous caesarean delivery contributed to the rise in all caesareans among multiparous mothers. Following adjustment, the risk of Indigenous nulliparous mothers having a caesarean with labour was 47% greater than for non-Indigenous nulliparous mothers [adjusted risk ratio 1.47 (95% CI 1.34–1.60)]. Conclusions: Increases in demographic and obstetric risk factors partially explained the increase in caesarean rates in the Northern Territory and the contribution of these factors differed between Indigenous and non-Indigenous mothers. Tweetable abstract: Caesarean section rates increased between 1986 and 2012 in the Northern Territory of Australia.
Formatted abstract
Objective:  To examine trends in caesarean section deliveries and factors associated with these trends for Indigenous and non-Indigenous mothers.

Design:  Total population-based study.

Setting:  Northern Territory of Australia, 1986–2012.

Population:  Pregnancies among Northern Territory residents, limited to singleton live births with cephalic presentations delivered at 37–42 weeks' gestation (n = 78 561).

Methods:  Descriptive analyses of demographic and obstetric risk factors. Poisson regression with robust variance to estimate the likelihood of caesarean delivery with and without labour compared with vaginal delivery, over time and between Indigenous and non-Indigenous mothers, adjusting for risk factors.

Main outcome measures:  
Trends in caesarean sections and risk of caesarean delivery compared with vaginal delivery.

Results:  The total rate of caesarean deliveries in the Northern Territory increased between 1986 and 2012. From the year 2000, the rise was driven by increases in caesareans with labour among nulliparous mothers and no labour caesareans among multiparous mothers. Increases in demographic and obstetric risk factors explained the rise in caesareans with labour among nulliparous Indigenous mothers, whereas other unmeasured variables contributed to the rise among non-Indigenous mothers. Increases in previous caesarean delivery contributed to the rise in all caesareans among multiparous mothers. Following adjustment, the risk of Indigenous nulliparous mothers having a caesarean with labour was 47% greater than for non-Indigenous nulliparous mothers [adjusted risk ratio 1.47 (95% CI 1.34–1.60)].

Conclusions:  Increases in demographic and obstetric risk factors partially explained the increase in caesarean rates in the Northern Territory and the contribution of these factors differed between Indigenous and non-Indigenous mothers.
Keyword Caesarean section
Indigenous
Trends
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Public Health Publications
 
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