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Primary Submission Category: Structural factors
Examining temporal trends in hospital-level obstetric intervention rates in Louisiana by funding and teaching status (2012-2024)
Authors: Regan Moss, Dovile Vilda, Kelli Hall,
Presenting Author: Regan Moss*
Background: Obstetric interventions such as induction of labor (IOL) and cesarean delivery are utilized with patients that are not clinically indicated for needing interventions. As such, while rates of IOL and cesarean delivery continue to rise across the entire birthing population, maternal and infant health outcomes have not drastically improved across the birthing population in the US writ large. While patient-level factors have been examined with regard to IOL and cesarean delivery rates, less is known as to how hospital-level factors may contribute to trends. Hospital-level factors, including funding source and teaching status, may affect intervention rates and their trajectories over time, yet remain underexamined relative to patient-level predictors. Understanding how institutional context drives variation in intervention use is critical for identifying targets for system-level change.
Methods: We will conduct a cross-sectional analysis of hospital records data on singleton live births in Louisiana from 2012-2024 using statewide vital records data. Jointpoint regression analysis will be used to assess temporal trends in cesarean delivery and IOL rates by year, with hospitals grouped by funding status (public vs. private) and teaching status. Trend analyses will be conducted at the hospital level among facilities with complete data across the study period.
Results: Preliminary analyses indicate that among the 36 birthing hospitals covering 774,682 births, cesarean delivery rates declined modestly from 2012 to 2024 (40.5% to 37.6%), while IOL trends increased over the same period. Specifically, IOL increased from 28.1% (2012) to 31.4% (2024).
Conclusions: This study will characterize how hospital funding and teaching status shape both the level and trajectory of obstetric intervention rates over more than a decade in Louisiana. Analyses will contribute to evidence on institutional drivers of medicalized birth with implications for hospital accountability and quality improvement policy.