{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:15:44Z","timestamp":1789708544262,"version":"4.0.1"},"reference-count":70,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Both globally and in Australia, there has been a sharp rise in cesarean births (CB). Commonly, this rise has been attributed to the changing epidemiology of women giving birth. A significant body of knowledge exists on the risk factors associated with a greater need for cesarean. Yet, we have little information on the reasons recorded by clinicians as to why cesareans are provided. This study aimed to explore the drivers of primary cesareans in Australian public hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using a linked administrative data set, the frequency and percent of mothers\u2019 characteristics were compared between those who had a cesarean birth and those who had a vaginal birth (n\u00a0=\u00a098\u00a0967) with no history of previous cesareans in Queensland public hospitals between July 1, 2012, and June 30, 2015. The top 10 reasons recorded by clinicians for a primary cesarean were reported. Using a machine\u2010learning algorithm, two decision trees were built to determine factors driving primary cesarean birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>\u201cLabour and delivery complicated by fetal heart rate anomaly\u201d (23%) and \u201cprimary inadequate contractions\u201d (22.8%) were the top two reasons for a primary cesarean birth. The most common characteristics among mothers who had fetal heart rate anomalies were as follows: artificial rupture of membranes (39%), oxytocin (32%), no obstruction of labor (42%), and epidural (52%). For women who had primary inadequate contractions, the most common characteristics were as follows: epidural (33%), oxytocin (49%), artificial rupture of membranes (45%), and fetal stress (56%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Efforts should be made by health practitioners during the antenatal period to maximize the use of preventative measures that minimize the need for medical interventions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12530","type":"journal-article","created":{"date-parts":[[2021,2,14]],"date-time":"2021-02-14T02:04:53Z","timestamp":1613268293000},"page":"209-220","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["A cascade of interventions: A classification tree analysis of the determinants of primary cesareans in Australian public hospitals"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6364-1516","authenticated-orcid":false,"given":"Haylee","family":"Fox","sequence":"first","affiliation":[{"name":"College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3448-7983","authenticated-orcid":false,"given":"Stephanie M.","family":"Topp","sequence":"additional","affiliation":[{"name":"College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lindsay","sequence":"additional","affiliation":[{"name":"College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7233-6804","authenticated-orcid":false,"given":"Emily","family":"Callander","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery Griffith University Meadowbrook Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31928-7"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31927-5"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.2217\/WHE.10.26"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-12-114"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2001.00009.x"},{"issue":"29","key":"e_1_2_7_7_1","first-page":"489","article-title":"Indications for and risks of elective cesarean section","volume":"112","author":"Mylonas I","year":"2015","journal-title":"Dtch \u00c4rzt Int"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.3755843"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-017-0363-y"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0210655"},{"key":"e_1_2_7_11_1","volume-title":"WHO Recommendations Non\u2010Clinical Interventions to Reduce Unnecessary Caesarean Sections","author":"World Health Organization","year":"2018"},{"key":"e_1_2_7_12_1","unstructured":"Australian Commission on Safety and Quality in Health Care (ACSQHC).Australian atlas of healthcare variation series.2015.https:\/\/www.safetyandquality.gov.au\/about\u2010us\/contact\u2010us\/. Accessed September 24 2018"},{"key":"e_1_2_7_13_1","volume-title":"National Core Maternity Indicators\u2013 Stage 3 and 4","author":"Australian Institute of Health and Welfare","year":"2016"},{"key":"e_1_2_7_14_1","volume-title":"Australia's Mothers and Babies 2017 \u2013 In Brief","author":"Australian Institute of Health and Welfare","year":"2019"},{"key":"e_1_2_7_15_1","volume-title":"National Core Maternity Indicators","author":"Australian Institute of Health and Welfare","year":"2019"},{"key":"e_1_2_7_16_1","article-title":"Doctors pushing mums\u2010to\u2010be for early delivery","author":"The Courier Mail","year":"2018","journal-title":"The Courier Mail"},{"key":"e_1_2_7_17_1","article-title":"WA caesarean birth rates highest on record as numbers of private c\u2010sections soar","author":"Collard S","year":"2018","journal-title":"ABC News"},{"key":"e_1_2_7_18_1","unstructured":"SBS.Are Government efforts to reduce the c\u2010section rate a good thing? A midwife argues yes.2018;https:\/\/www.sbs.com.au\/news\/the\u2010feed\/debate\u2010are\u2010government\u2010efforts\u2010to\u2010reduce\u2010the\u2010c\u2010section\u2010rate\u2010a\u2010good\u2010thing\u2010a\u2010doctor\u2010argues\u2010no"},{"key":"e_1_2_7_19_1","article-title":"Caesarean rates soar with doctors 'less prepared to take risks'","author":"Dow A","year":"2018","journal-title":"The Sydney Morning Herald"},{"key":"e_1_2_7_20_1","volume-title":"Australia's Mothers and Babies 1991","author":"Lancaster PAL","year":"1994"},{"key":"e_1_2_7_21_1","volume-title":"Australia's Mothers and Babies 2016 \u2013 In Brief","author":"Australian Institute of Health and Welfare","year":"2018"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12674"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-001723"},{"key":"e_1_2_7_24_1","unstructured":"FoxH CallanderE.The potential for big data to improve health systems research: using the Maternity 1000 model to examine the socioeconomic characteristics of mothers receiving obstetric intervention during labour and birth in Australia. Fifth Global Symposium on Health Systems Research; 12th October 2018; Liverpool United Kingdom.2018."},{"key":"e_1_2_7_25_1","unstructured":"GilesG HerkesR.The Australian Atlas of Healthcare Variation series.2018."},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-017816"},{"key":"e_1_2_7_27_1","volume-title":"International Statistical Classification of Diseases and Related Health Problems, Eighth Revision, Australian Modification","author":"Australian Consortium for Classification Development","year":"2013"},{"key":"e_1_2_7_28_1","unstructured":"NCaC Centre.The International Statistical Classification of Diseases and Related Health Problems. Tenth Revision Australian Modification (ICD\u201010\u2010AM). Sydney Australia;2013."},{"key":"e_1_2_7_29_1","unstructured":"World Health Organisation.Body Mass Index.2000;http:\/\/www.euro.who.int\/en\/health\u2010topics\/disease\u2010prevention\/nutrition\/a\u2010healthy\u2010lifestyle\/body\u2010mass\u2010index\u2010bmi"},{"key":"e_1_2_7_30_1","unstructured":"Australian Bureau of Statistics.2033.0.55.001 \u2013 Census of Population and Housing: Socio\u2010Economic Indexes for Areas (SEIFA) Australia 2016.2018;http:\/\/www.abs.gov.au\/ausstats\/abs@.nsf\/Lookup\/by%20Subject\/2033.0.55.001~2016~Main%20Features~SOCIO\u2010ECONOMIC%20INDEXES%20FOR%20AREAS%20(SEIFA)%202016~1. Accessed September 28 2018"},{"key":"e_1_2_7_31_1","unstructured":"Queensland Government.Accessibility\/Remoteness Index of Australia.2018;http:\/\/www.qgso.qld.gov.au\/about\u2010statistics\/statistical\u2010standards\/national\/aria.php. Accessed September 28 2018."},{"key":"e_1_2_7_32_1","unstructured":"SAS institute.SAS\/STAT\u00ae14.1 User\u2019s Guide. NC;2015."},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1207\/S15324796ABM2603_02"},{"key":"e_1_2_7_34_1","unstructured":"Australian Institute of Health and Welfare.Australia's mothers and babies 2008. Canberra;2010."},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(02)70182-8"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq311"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.2002.811107.x"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/00115550-200111000-00011"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181e10c5c"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01298.x"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200308000-00014"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.458"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(99)00377-4"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01213.x"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70265-6"},{"issue":"1","key":"e_1_2_7_46_1","first-page":"25","article-title":"Maternal and neonatal morbidity among nulliparous women undergoing elective induction of labor","volume":"56","author":"Vardo JH","year":"2011","journal-title":"J Reprod Med"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)34372-9"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.08.061226"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.07.003"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00007"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182a6a4d0"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01160.x"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.09.019"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)34241-4"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002425"},{"key":"e_1_2_7_56_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.130925"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181c4ef96"},{"key":"e_1_2_7_58_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e2838"},{"key":"e_1_2_7_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2018.08.109"},{"key":"e_1_2_7_60_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800566"},{"key":"e_1_2_7_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.12.021"},{"key":"e_1_2_7_62_1","volume-title":"WHO Recommendations: Induction of Labour at or Beyond Term","author":"World Health Organization","year":"2018"},{"key":"e_1_2_7_63_1","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12621"},{"key":"e_1_2_7_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(68)90567-X"},{"key":"e_1_2_7_65_1","doi-asserted-by":"publisher","DOI":"10.1177\/0884217503258528"},{"key":"e_1_2_7_66_1","volume-title":"WHO Recommendations for Induction of Labour","author":"World Health Organization","year":"2011"},{"key":"e_1_2_7_67_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-017816"},{"key":"e_1_2_7_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2017.10.001"},{"key":"e_1_2_7_69_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-46"},{"key":"e_1_2_7_70_1","first-page":"CD004667","article-title":"Midwife\u2010led continuity models of care compared with other models of care for women during pregnancy, birth and early parenting","volume":"4","author":"Sandall J","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_71_1","volume-title":"Intrapartum Fetal Surveillance","author":"The Royal Australian and New Zealand College of Obstetricians and Gynaecologists","year":"2019"}],"container-title":["Birth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/birt.12530","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/birt.12530","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/birt.12530","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T21:46:00Z","timestamp":1693604760000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/birt.12530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,11]]},"references-count":70,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1111\/birt.12530"],"URL":"https:\/\/doi.org\/10.1111\/birt.12530","archive":["Portico"],"relation":{},"ISSN":["0730-7659","1523-536X"],"issn-type":[{"value":"0730-7659","type":"print"},{"value":"1523-536X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,11]]},"assertion":[{"value":"2020-05-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}