Primary Cesarean Birth Rates Among Women With Obesity at Urban and Rural Hospitals in the [6T

Abstract

INTRODUCTION: Studies have demonstrated that the rate of Cesarean birth (CB) is increased among women with obesity. 14% of births among women with class III obesity occur in rural areas. We aimed to investigate whether the relative risk of CB for women with obesity varied by location of birth (rural versus urban). METHODS: The Natality Data Set of live births in the United States between 2014 and 2015 was queried for nulliparous, vertex, term births. BMI was classified into eight groups defined by WHO criteria with sub-stratification of class III every 5 kg/m2 up to BMI ≥50 kg/m2. Rates of CB were assessed according to the National Center for Health Statistics' county-level urban-rural classification scheme. RESULTS: The rate of CB per 1000 live births increased with BMI across all geographic categories (highest RR 3.89 (95%CI 2.20-6.90) for BMI 50+). The rate of CB among women with BMI between 40 and 44.9, 45 and 49.9 and ≥50 kg/m2 was proportionally higher than expected (due to BMI alone) for rural hospitals (RR 1.21 (95% CI 1.17-1.25), RR 1.33 (95% CI 1.27-1.39), and RR 1.30 (95% CI 1.23-1.37), respectively). A higher proportion of all deliveries at rural hospitals occurred among women with obesity compared to urban hospitals. CONCLUSION: The relative risk of CB for women with BMI ≥-40 kg/m2 was higher than expected in rural hospitals. Rural hospitals proportionally deliver more women with obesity of all strata. This indicates that rural facilities require operative equipment to accommodate obesity and may indicate rural-urban disparities that warrant further investigation.