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  • Leah L. Albers CNM, DrPH,

    Corresponding author
    1. Leah L. Albers received her nursing degrees from Vanderbilt University (BSN, 1971; MSN, 1974). She studied nurse-midwifery at the University of Medicine and Dentistry of New Jersey (1977). She was in full-scope practice for 11 years, and then completed the DrPH degree at the University of North Carolina School of Public Health (1990). She is an assistant professor at the University of New Mexico College of Nursing, and has a joint appointment in the Department of Obstetrics and Gynecology, University of New Mexico School of Medicine.
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  • Mona T. Lydon-Rochelle CNM, MSN,

    1. Mona T. Lydon-Rochelle studied nurse-midwifery at the Frontier Nursing Service School of Midwifery (1977). She received her nursing degrees from the University of New Mexico (BSN, 1988) and Case Western Reserve University (MSN, 1992). She has practiced full-scope midwifery in a variety of settings. She directed the research program for the Nurse-Midwifery Division at the University of New Mexico for 3 years and has recently begun the doctoral program at the University of Washington School of Nursing.
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  • Cara J. Krulewitch PhD, RN

    1. Cara J. Krulewitch received a nursing diploma from the Evanston Hospital School of Nursing in 1978. Her nursing degrees are from the University of Illinois at Chicago (BSN, 1982; MSN, 1984). She completed the PhD in nursing, with a focus in perinatal epidemiology, from the University of Maryland in 1992. She has an extensive background in statistical methods and computer technology. She was with the Followback Survey Branch of the National Center for Health Statistics at the time of this study.
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Address correspondence to Leah L. Albers, University of New Mexico College of Nursing, Albuquerque, NM 87131–1061.


The objective of this study was to describe the association between maternal age and selected risk indicators (both recognized and potential) to determine whether any were predictive of labor complications in women having a first child. Low-risk primigravidas (n = 1,792) were selected from a large national probability sample of births for 1988 (the National Maternal and Infant Health Survey). Recognized and potential risk indicators were described according to categories of maternal age and the occurrence of labor problems. Stratified analysis and logistic regression were used to assess the association of various risk factors with labor complications adjusted for maternal age. Only cesarean delivery varied significantly across maternal age groups, the rate being 11.6% for those < 20, 15.9% for those age 20–29, and 28.3% for those ≥ 30. Cesarean delivery was associated with several characteristics of social advantage. Independent risk factors for cesarean delivery were maternal age (particularly ≥ 30), epidural anesthesia, and receipt of adequate prenatal care. We conclude that older primigravidas have significantly more cesarean deliveries, and this is partially explained by characteristics of social advantage. To address the high cesarean rate, care providers need a better understanding of the relationship between social circumstances and cesarean delivery.