Relative Risk of Postpartum Complications in the Ohio Medicaid Population: Vaginal Versus Cesarean Delivery

The objective of this study was to estimate the relative risk of postpartum complication by type of delivery among Ohio Medicaid beneficiaries. The study uses the linked Medicaid and Ohio birth certificate data for births occurring from July 1991 through April 1996 (N = 168,736). The results indicate that the incidence of major puerperal infection, thromboembolic events, anesthetic complications, and obstetrical surgical wound infection was higher among women undergoing a C-section as compared to those with vaginal delivery, even after limiting the analysis to elective cesarean deliveries and uncomplicated vaginal deliveries. On the other hand, women with C-sections were less likely to experience obstetrical trauma, and results on postpartum hemorrhage were inconclusive. Aside from obstetrical trauma, the relative risk of postpartum complications remains significantly higher among women undergoing C-section. These findings are of particular relevance in light of the substantial proportion of repeat C-sections performed on an elective basis.