Effect of Method of Delivery on Birth Trauma and
Length of Stay in hospitals
Sunil Nair – B00492855
HINF6110-Systems & Issues Presentation
Masters Program, Health Informatics
Dalhousie University
November 30, 2007
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Abstract
Objectives: To compare the effect of regular or normal delivery and cesarean
delivery resulting in neonatal birth trauma and to ascertain the length of stay for
infants with birth trauma in US hospitals. Methods: Discharge data was obtained
from the National Hospital Discharge Survey (NHDS) from the National Center
of Health Statistics (NCHS) website. A total of 96,618 discharges of all deliveries
from 01 January 2005 to 31 December 2005 from participating hospitals across
the US were used. The selected diagnostic categories included all diagnosis under
International Classification of Disease version 9 Clinical Modification (ICD-9-
CM) code ‘767’ for birth trauma. This study included singleton live born infants;
twin born and admissions referred from other hospitals due to complications were
excluded from the study. SAS was used for statistical analysis. Results: Regular
deliveries showed a significantly higher rate, 72.91%, of neonatal birth trauma
and only 20.25% cases of Cesarean sections resulted in birth trauma to the infant.
The average length of stay in both regular and cesarean deliveries that resulted in
birth trauma was 3 days (regular 3.04% and cesarean 2.56%). The average lengths
of stay in proprietary hospitals for both regular and cesarean deliveries were 2
days. Conclusion: Birth trauma to the infant is more likely to occur due to
complications of regular vaginal delivery than cesarean section. By analyzing this
data, it can be assumed that complications due to Cesarean deliveries were less in
proprietary hospitals than in government and non-profit hospitals.
1. Introduction
“Injuries to the infant that result from mechanical forces like compression and traction
during the birth process are categorized as birth trauma” [Nirupama Laroia 2006]. The
outcome of birth process is influenced by various risk factors which includes the size and
weight of the baby, use of instruments during deliveries, unfavorable positioning of the
baby at the time of birth and several maternal conditions. Studies have shown that, in the
US there has been an increase in infant mortality rate, 7 infant deaths per 1000 live birth
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in 2002; 1 but deaths due to birth trauma are extremely low (<2%). 2 This decrease in birth
trauma injury has been attributed to early identification of the risk factors and opting for
Cesarean section (CS) over normal vaginal delivery. 3 In developing countries where the
infant mortality and neonatal deaths due to birth trauma are significantly high there is a
rising trend to choose cesarean 4 at the expense of maternal health. Studies have shown
that in places where patients prefer proprietary hospitals over government because of the
disparity in care conditions, cesarean section is encouraged by private hospitals for
profitability. 5
Some studies have indicated that in the U.S, the number of cesarean delivery are
increasing and growing in acceptance as an elective birth option. 6 While some
researchers claim that the rate has decreased in the recent years because of economic
factors and burden of insurance coverage due to the increased costs associated with
cesarean deliveries. 7 This paper examines the number of infants born with birth trauma in
the year 2005 and attempts to correlate this with the method of delivery and its influence
on number of days of care at government and private hospitals.
Methods
The data was obtained from the National hospital discharge survey dataset from the
National Center for Health statistics website representing a sample of short-stay hospital
discharges in the U.S. The study was designed to include all singleton live births
delivered with a diagnosis of birth trauma (ICD-9-CM code ‘767’) in all participating US
hospitals between 01 January 2005 and 31 December 2005. Exclusions criteria included
all twin born deliveries with trauma and those cases were the birth process was
commenced or attempted elsewhere and was diagnosed with birth trauma upon admission
to the hospital. The data was then compiled and analyzed using SAS software
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Results
In the 2005 NHDS dataset, the total number of discharges that had a diagnosis of birth
trauma to the infant was 96,618. Of this total, regular or vaginal deliveries that resulted in
trauma to the infant were 59,062 (72.9%) and cesarean section accounted for only 20.2%.
80
70
60
50
40 Regular
Cesarean
30
20
10
0
Birth trauma
Non-profit hospitals recorded higher incidence of birth trauma and was significantly
higher in regular deliveries than cesareans.
80
70
60
50
Private
40
Govt
30 Non-Profit
20
10
0
Regular Cesarean
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Conclusions
Birth trauma to the infant is more likely to occur due to complications arising out of
regular vaginal delivery than cesarean delivery. The length of stay for infants born with
trauma in regular and cesarean delivery was found to be 2 days. This decreased days of
care at private, government and non-profit hospitals may be due to increased burden of
insurance coverage. There is no conclusive evidence from the data that private hospitals
encourage cesarean deliveries.
References:
1
Supplemental Analyses of Recent Trends in Infant Mortality. Kenneth D. Kochanek, M.A., and Joyce A.
Martin, M.P.H.http://www.cdc.gov/nchs/products/pubs/pubd/hestats/infantmort/infantmort.htm
2
Birth Trauma. Nirupama Laroia MD, Department of Pediatrics, Division of Neonatology, Children's
Hospital at Strong and University of Rochester. OCT 2006 http://www.emedicine.com/ped/topic2836.htm
3
Choosing caesarean section. Marsden Wagner MD The Lancet, Volume 356, Issue 9243, 18 November
2000, Page 1697
4
A critical appraisal of cesareannext term section rates at teaching hospitals in previous termIndianext term
I. Kambo, N. Bedi, B. S. Dhillon and N. C. Saxena 5 November 2002
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7M-47533B0-
4&_user=6394546&_coverDate=11%2F30%2F2002&_alid=656655936&_rdoc=2&_fmt=full&_orig=sear
ch&_cdi=5062&_sort=d&_docanchor=&view=f&_ct=8&_acct=C000051270&_version=1&_urlVersion=0
&_userid=6394546&md5=a5947e4e6af6452b5c83cb476ae6f632#bib5
5
S. Sreevidya, B.W.C. Sathiyasekaran (2003) High caesarean rates in Madras (India): a population-based
cross sectional study BJOG: An International Journal of Obstetrics and Gynaecology 110 (2), 106–111.
doi:10.1046/j.1471-0528.2003.02006.x
6
H. Minkoff and F.A. Chervenak, Elective primary cesarean delivery, N Engl J Med 348 (2003), pp. 946–
950.
7
Decline in U.S. Cesarean Delivery Rate Appears to Stall Birth. Sally C. Curtin MA, Lola Jean Kozak PhD
Volume 25 Issue 4 Page 259-262, December 1998.
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