Abstract
Objective
Previous studies have identified an association between obstetric interventions and
the time of day in which they are performed; however, they do not account for granular
variations in the temporality of delivery interventions, which is influenced by both
health care providers and resource availability. We sought to assess differences in
time of birth among spontaneous vaginal births (SVBs) versus operative (forceps- and
vacuum-assisted) vaginal births (OVBs).
Study Design
This cross-sectional study used birth certificate data from the National Vital Statistics
System from 2016 to 2021, which includes the time of birth and delivery method for
recorded U.S. births. The number of SVBs and OVBs at each minute was normalized relative
to the total births within each delivery group to facilitate balanced comparisons
between groups. Logistic regression analysis assessed the odds of OVBs per time of
day.
Results
A total of 15,412,129 subjects who underwent vaginal birth were included in this analysis,
690,905 (4.5%) of whom underwent OVBs. Compared to births at other time intervals,
those between 4:30 and 7:30 p.m. were more likely to be OVBs (odds ratio [OR] = 1.13,
95% confidence interval [CI]: 1.12–1.14). Conversely, births between 3:00 and 6:00
a.m. were less likely to be OVBs (OR = 0.87, 95% CI: 0.86–0.88). After adjusting for
adjusting for maternal age, gestational age, and induction of labor, births between
4:30 and 7:30 p.m. remained more likely to be OVBs (adjusted odds ratio [aOR] = 1.09,
95% CI: 1.08–1.10) and births between 3:00 and 6:00 a.m. remained less likely to be
OVBs (aOR = 0.91, 95% CI: 0.90–0.92).
Conclusion
In this population-based study, we identified temporal differences between SVBs and
OVBs with increased use of instrumentation during the late afternoon and reduced use
in the early morning. These findings prompt further investigation into the indications
for OVBs and root causes of these temporal variations, which are likely multifactorial
and involve provider and resource availability.
Key Points
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This study identifies temporal differences between SVBs and OVBs.
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Compared to SVBs, operative births are more likely in the late afternoon.
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OVBs are also less likely in the early morning.
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These temporal trends suggest the influence of provider and resource availability.
Keywords
obstetric interventions - temporal variations - operative vaginal births - birth timing
