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dc.contributor.advisorAnda, Erik Eik
dc.contributor.authorNedberg, Ingvild Hersoug
dc.date.accessioned2022-03-16T09:31:50Z
dc.date.available2022-03-16T09:31:50Z
dc.date.issued2022-04-06
dc.description.abstractHigh rates of cesarean section are associated with increased mortality and morbidity. To decrease cesarean sections without medical indication is complex and requires in-depth knowledge of local context and which groups to target for possible interventions. Our aim was to assess the role of maternal risk factors in relation to cesarean section in Georgia and Norway, two countries with diverging rates of cesarean sections. In addition, we wanted to assess the impact of a financial punitive policy with the aim to curb the high cesarean section rate in Georgia. The thesis consists of three studies, all of which used data from national birth registries. The first study assessed the relationship between maternal factors and cesarean section among primiparous women in Georgia. The second study assessed the prevalence of maternal risk factors for cesarean section over time and their relationship with the observed increase in cesarean sections in Norway. The third study assessed the impact of a financially punitive policy on rates of CS and perinatal outcomes in Georgia. Among primiparous women in Georgia, age ≥35 years, obesity, and birthweight ≥4000 g were strongly associated with cesarean section, while the proportion of women with risk factors for cesarean section was not unusually high. In Norway, the proportion of women with risk factors for cesarean section increased over time. Despite this development, the national cesarean section rate has remained stable since 2005. The financial policy did reduce the cesarean section rate in Georgia, mainly among primiparous women. We could not find that the policy impacted transfer to neonatal intensive care units or perinatal mortality. Our findings from Georgia and Norway indicate that maternal risk factors are not an important contributor to the increasing proportions of cesarean section. Financial regulations may play a role in reducing high rates of cesarean section but should be implemented with caution.en_US
dc.description.doctoraltypeph.d.en_US
dc.description.popularabstractThe world-wide increase in cesarean sections without medical indication is a problem. They are both costly and can cause unnecessary harm. To reduce high rates of cesarean sections is difficult because it requires precise knowledge of local conditions and which groups to target. This thesis examines the role of maternal factors in relation to changing rates of cesarean section in Georgia and Norway and the effects of a financial policy to reduce cesarean sections. In Georgia, high maternal age, obesity and having a large baby were associated with cesarean sections. In Norway, the proportion of women with risk factors has increased, while proportions of cesarean sections have remained stable. The policy in Georgia did reduce cesarean sections without impacting perinatal outcomes. These findings indicate that maternal factors are not an important contributor to the increase in cesarean sections and that financial regulations may play a role in reducing high rates of cesarean section.en_US
dc.identifier.urihttps://hdl.handle.net/10037/24424
dc.language.isoengen_US
dc.publisherUiT The Arctic University of Norwayen_US
dc.publisherUiT Norges arktiske universiteten_US
dc.relation.haspart<p>Paper I: Nedberg, I.H., Rylander, C., Skjeldestad, F.E., Blix, E., Ugulava, T. & Anda, E.E. (2020). Factors associated with cesarean section among primiparous women in Georgia: a registry-based study. <i>Journal of Epidemiology and Global Health, 10</i>(4), 337-343. Also available in Munin at <a href=https://hdl.handle.net/10037/20427>https://hdl.handle.net/10037/20427</a>. <p>Paper II: Nedberg, I.H., Lazzerini, M., Mariani, I., Møllersen, K., Valente, E.P., Anda, E.E. & Skjeldestad, F.E. (2021). Changes in maternal risk factors and their association with changes in cesarean sections in Norway between 1999 and 2016: A descriptive population-based registry study. <i>PLoS Medicine, 18</i>(9), e1003764. Also available in Munin at <a href=https://hdl.handle.net/10037/22636>https://hdl.handle.net/10037/22636</a>. <p>Paper III: Nedberg, I.H., Manjavidze, T., Rylander, C., Blix, E., Skjeldestad, F.E. & Anda, E.E. Changes in cesarean section rates after the introduction of a punitive financial policy in Georgia: a population-based registry study 2017-2019. (Submitted manuscript). Now published in <I>PLoS ONE, 17</i>(7), e0271491, available at <a href=https://doi.org/10.1371/journal.pone.0271491>https://doi.org/10.1371/journal.pone.0271491</a>.en_US
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2022 The Author(s)
dc.rights.urihttps://creativecommons.org/licenses/by-nc-sa/4.0en_US
dc.rightsAttribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)en_US
dc.subjectVDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801en_US
dc.subjectVDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801en_US
dc.subjectVDP::Medical disciplines: 700::Health sciences: 800::Epidemiology medical and dental statistics: 803en_US
dc.subjectVDP::Medisinske Fag: 700::Helsefag: 800::Epidemiologi medisinsk og odontologisk statistikk: 803en_US
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Gynecology and obstetrics: 756en_US
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Gynekologi og obstetrikk: 756en_US
dc.titleCesarean sections in Georgia and Norway - What contributes to too much, too little, or just right? The role of maternal risk factors and efforts to reduce high cesarean section ratesen_US
dc.typeDoctoral thesisen_US
dc.typeDoktorgradsavhandlingen_US


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