Degree Name

MPH (Master of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Richard Wissell

Committee Members

Bruce Goodrow, Eveyln Knight


This study consists of an analysis of hospital discharge data from three Northeast Tennessee hospitals to identify maternal demographic factors that may be linked to higher rates of cesarean sections in this region of Appalachia. Maternal age, race, insurance status, length of stay, and birth weight were evaluated to identify regional trends in the prevalence of these factors over a two-year period.

There were 1,678 (23.3%) singleton live births by cesarean section of which 7.6% were repeat cesarean section deliveries. Less than one percent of the 7,181 births were vaginal births after cesarean (VBAC) delivery. Overall, insurance and maternal age was found to be significant predictors of cesarean delivery. Using stepwise logistic regression, age was found to be a significant predictor of cesarean birth for women less than 35 years of age. Significance was found for cesarean birth and insurance status (OR=1.09, 95% CI=1.00,1.19) and for cesarean birth and mother’s age (OR=1.31, 95% CI=1.21,1.41).

Mothers under the age of 35 who were insured under a managed care plan were at significant risk for cesarean section delivery. This study was limited in that only hospital discharge data were available and the study population was relatively homogeneous. Further research of this population is needed to continue investigation of the predictors of cesarean birth.

Document Type

Thesis - unrestricted


Copyright by the authors.