Meghan Little

Bio 1615- 018

Article Summary
The Effect of Delaying Childbirth on Primary Cesarean Section Rates

Introduction
For the last twenty years, cesarean section rates have been rising, bringing concern to many
healthcare providers and families all over the world. Although there are risks associated with any type
of delivery, there are very specific risks associated with cesarean delivery. Mothers could react poorly
to the anesthesia, there could be complications due to blood loss, or the healing of the incision, etc. In
the United States alone, the rate of cesarean section deliveries was 30.2% in 2005. This is a rise of
46% since 1996. There are, of course, many factors that determine whether a women delivers her baby
via cesarean section or vaginal delivery. However, this sharp of an increase over time suggests that
there is a factor that is significantly outweighing others to create a situation where mother mothers
deliver via cesarean section. Some believe that the increase is due primarily to physician preference, as
it is a faster way to deliver babies. Perhaps it is maternal preference, as many of the unknowns of
delivery are eliminated- there is a specific date and time set for the arrival of the baby and in many
cases, no pain is felt. The rate of cesarean section rises sharply with age, leading many to believe that
maternal age is a risk factor for a cesarean delivery. The researchers of this study wanted to see if that
was the case.

Materials and Methods

This study was done to characterize the association between maternal age and the outcome of
labor, to determine the proportion of increase in primary cesarean rates that could be attributed to
changes in maternal age distribution and to determine whether the contractility of uterine smooth

muscle (myometrium) varied with maternal age.

To find the association between maternal age and the outcome of labor, and to see what
proportion of the increase in cesarean rates could be attributed to age, the researchers analyzed data that
they collected from the Scottish Morbidity Record from 1980-2005. They chose this data set because it
has been shown to be 99% complete since the late 1970's and more than 98% of the records do not
have substantial errors.
To determine whether the contractility of uterine smooth muscle (myometrium) varied with
maternal age, they biopsied the uteri of 62 women that were undergoing a routine cesarean delivery to
test for contractility. They found that advanced age was associated with a lesser amount of spontaneous
contraction, and that the uteri had a different type of spontaneous contaction.

Results
This data showed a linear association between the risk of having a cesarean delivery and
advancing maternal age in first pregnancies. That means that a higher age correlates with a higher rate
of cesarean delivery. This data also showed that the cesarean rate more than doubled between 1980 and
2005. The researchers then determined that 38% of the procedures would have been avoided if women
had delivered their first child at a younger age (as was common in 1980). Given this information, they
concluded that a large part of the increase could be associated with mothers giving birth to their first
child at a later age.
The results of this study mean that higher maternal age is associated with higher rates of
cesarean sections. It also gives an idea of what may be causing the higher rate of cesarean sections in
older women- uterine contractile function.

Discussion
The researchers believe that women who choose to deliver their first baby later in life have a

higher rate of cesarean section because their uterus does not contract like that of a younger woman.
They believe this is due to prolonged stimulation of the uterus by estrogen and progesterone,
although that research was not a part of this study.
The researchers go on to aknowledge that more reasearch needs to be done to fully understand
the causes of the increase in cesarean deliveries, and to ensure that we can find an option that provides
the best care and outcome for women and babies everywhere.

Bibliography
Smith, Gordon C. S., Yolande Cordeaux, Ian R. White, Dharmintra Pasupathy, Hannah MissfelderLobos, Jill P. Pell, D. Stephen Charnock-Jones, Michael Fleming, and Nicholas Fisk. "The Effect of
Delaying Childbirth on Primary Cesarean Section Rates." PLoS Medicine: E144. Web. 26 Mar.
2015