BACKGROUND: Fertility postponement, which has comprised the most significant reproductive trend in developed countries over the last few decades, involves a number of social, personal and health consequences. The length of stay (LOS) in hospital following childbirth varies considerably between countries. Czechia, where the fertility postponement process has been particularly dynamic, has one of the longest mean LOS of the OECD member countries. OBJECTIVE: We analyse the influence of the age of mothers on the LOS in hospital associated with childbirth. DATA AND METHODS: We employed anonymised individual data provided by the General Health Insurance Company of the Czech Republic on women who gave birth in 2014. Kaplan-Meier survival plots and binary logistic regression were employed to identify factors associated with long stays (> = 7 days for vaginal births, > = 9 days for CS births). RESULTS: The impact of the maternal age on the LOS is U-shaped. A higher risk of a longer hospitalisation period for young mothers was identified for both types of birth (OR = 1.58, 95% CI 1.33-1.87, p˂0.001 for age less than 20, OR = 1.31, 95% CI 1.20-1.44, p˂0.001 for age 20-24 compared to 30-34). The risk of a longer stay in hospital increases with the increasing age of the mother (OR = 1.23, 95% CI 1.13-1.35, p˂0.001 for age 35-39, OR = 2.05, 95% CI 1.73-2.44, p˂0.001 for age 40+ compared to 30-34), especially with concern to vaginal births. CONCLUSION: The probability of a long LOS increases significantly after the age of 35, especially in the case of vaginal births. Thus, the fertility postponement process with the significant change in the age structure of mothers contributes to the increase in health care costs associated with post-birth hospitalisation.

Department of Demography and Geodemography Faculty of Science Charles University Prague Czechia

Department of Health Care Studies College of Polytechnics Jihlava Jihlava Czechia

Department of Obstetrics and Gynaecology 2nd Faculty of Medicine Charles University Prague Czechia

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Burkimsher M. Europe-wide fertility trends since the 1990s: turning the corner from declining first birth rates. Demographic Research. 2015;32:621–56. doi: 10.4054/DemRes.2015.32.21 DOI

Sobotka T. Post-transitional fertility: the role of childbearing postponement in fuelling the shift to low and unstable fertility levels. J Biosoc Sci. 2017. Nov;49(S1):S20–S45. doi: 10.1017/S0021932017000323 . PubMed DOI

Kocourková J, Šťastná A. The realization of fertility intentions in the context of childbearing postponement: comparison of transitional and post-transitional populations. J Biosoc Sci. 2021 Jan;53(1):82–97. doi: 10.1017/S002193202000005X Epub 2020 Mar 10. PMID: . PubMed DOI

Šprocha B, Fitalová A. Late motherhood and spatial aspects of late fertility in Slovakia. Moravian Geographical Reports. 2022;30(2): 86–98. doi: 10.2478/mgr-2022-0006 DOI

Šprocha B. [Childlessness and the Postponement of First Births in the Visegrad Countries]. Demografie. 2022;64(2): 139–157. doi: 10.54694/dem.0302 Slovak. DOI

Kenny LC, Lavender T, McNamee R, O’Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS One. 2013;8(2):e56583. doi: 10.1371/journal.pone.0056583 Epub 2013 Feb 20. PMID: ; PMCID: PMC3577849. PubMed DOI PMC

Hidalgo-Lopezosa P, Jiménez-Ruz A, Carmona-Torres JM, Hidalgo-Maestre M, Rodríguez-Borrego MA, López-Soto PJ. Sociodemographic factors associated with preterm birth and low birth weight: A cross-sectional study. Women Birth. 2019. Dec;32(6):e538–e543. doi: 10.1016/j.wombi.2019.03.014 Epub 2019 Apr 9. PMID: . PubMed DOI

Syse A, Thomas M, Dommermuth L, Hart RK. Does women’s health matter for fertility? Evidence from Norwegian administrative data. Popul Stud (Camb). 2022. Jul;76(2):191–212. doi: 10.1080/00324728.2022.2041075 Epub 2022 Mar 8. PMID: . PubMed DOI

Rydahl E, Declercq E, Juhl M, Maimburg RD. Cesarean section on a rise-Does advanced maternal age explain the increase? A population register-based study. PLoS One. 2019. Jan 24;14(1):e0210655. doi: 10.1371/journal.pone.0210655 ; PMCID: PMC6345458. PubMed DOI PMC

Fait T, Šťastná A, Kocourková J, Waldaufová E, Šídlo L, Kníže M. Has the cesarean epidemic in Czechia been reversed despite fertility postponement? BMC Pregnancy Childbirth. 2022. Jun 6;22(1):469. doi: 10.1186/s12884-022-04781-1 ; PMCID: PMC9172003. PubMed DOI PMC

Lodge-Tulloch NA, Elias FTS, Pudwell J, Gaudet L, Walker M, Smith GN, Velez MP. Caesarean section in pregnancies conceived by assisted reproductive technology: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2021. Mar 22;21(1):244. doi: 10.1186/s12884-021-03711-x ; PMCID: PMC7986269. PubMed DOI PMC

Yakin K, Urman B, Balaban B. Dynamic view of assisted reproduction in Turkey from 1996 to 2020. Reprod Biomed Online. 2022. Apr;44(4):747–754. doi: 10.1016/j.rbmo.2021.12.010 Epub 2021 Dec 18. PMID: . PubMed DOI

Grewe S, Grewe C, Diedrich K. Geburtshilfliche Risiken nach assistierter Reproduktion [Obstetric risks after assisted reproduction]. 2019; Gynäkologe, 52: 659–66. doi: 10.1007/s00129-019-4486-7 German. DOI

Czech Statistical Office. [Demographic Yearbook of the Czech Republic– 2021] [cited 2023 January 20]. Czech. Available from: https://www.czso.cz/csu/czso/demograficka-rocenka-ceske-republiky-2021

Richards MK, Flanagan MR, Littman AJ, Burke AK, Callegari LS. Primary cesarean section and adverse delivery outcomes among women of very advanced maternal age. J Perinatol. 2016 Apr;36(4):272–7. doi: 10.1038/jp.2015.204 Epub 2016 Jan 7. PMID: . PubMed DOI

Schimmel MS, Bromiker R, Hammerman C, Chertman L, Ioscovich A, Granovsky-Grisaru S, et al.. The effects of maternal age and parity on maternal and neonatal outcome. Arch Gynecol Obstet. 2015. Apr;291(4):793–8. doi: 10.1007/s00404-014-3469-0 Epub 2014 Sep 17. PMID: . PubMed DOI

Wyles K, Miller YD. Does it get better with age? Women’s experience of communication in maternity care. Women Birth. 2019. Jun;32(3):e366–e375. doi: 10.1016/j.wombi.2018.08.170 Epub 2018 Sep 8. PMID: . PubMed DOI

Leung KM, Elashoff RM, Rees KS, Hasan MM, Legorreta AP. Hospital- and patient-related characteristics determining maternity length of stay: a hierarchical linear model approach. Am J Public Health. 1998. Mar;88(3):377–81. doi: 10.2105/ajph.88.3.377 ; PMCID: PMC1508339. PubMed DOI PMC

Liu S, Heaman M, Kramer MS, Demissie K, Wen SW, Marcoux S, et al.. Length of hospital stay, obstetric conditions at childbirth, and maternal readmission: a population-based cohort study. Am J Obstet Gynecol. 2002. Sep;187(3):681–7. doi: 10.1067/mob.2002.125765 . PubMed DOI

Matthews KC, Tesfamariam R, Chasen ST, Kalish RB. Factors affecting hospital length of stay after cesarean delivery. American Journal of Obstetrics and Gynecology 2020;222(1):694–95. doi: 10.1016/j.ajog.2019.11.1141 DOI

Kruse AR, Arendt LH, Jakobsen DH, Kehlet H, Lauszus FF, Forman A, et al.. Length of hospital stay after cesarean section in Denmark from 2004 to 2016: A national register-based study. Acta Obstet Gynecol Scand. 2021. Feb;100(2):244–251. doi: 10.1111/aogs.14000 Epub 2020 Oct 16. PMID: . PubMed DOI

Gauci PA, Adrados C, Delotte J. Early postpartum discharge before 48 h: An exhaustive review. J Gynecol Obstet Hum Reprod. 2022. Nov;51(9):102458. doi: 10.1016/j.jogoh.2022.102458 Epub 2022 Aug 13. PMID: . PubMed DOI

Campbell OM, Cegolon L, Macleod D, Benova L. Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys. PLoS Med. 2016. Mar 8;13(3):e1001972. doi: 10.1371/journal.pmed.1001972 ; PMCID: PMC4783077. PubMed DOI PMC

WHO Recommendations on Postnatal Care of the Mother and Newborn. Geneva: World Health Organization; 2013 Oct. PMID: 24624481. Available at: https://apps.who.int/iris/handle/10665/97603 PubMed

Ford JB, Algert CS, Morris JM, Roberts CL. Decreasing length of maternal hospital stay is not associated with increased readmission rates. Aust N Z J Public Health. 2012. Oct;36(5):430–4. doi: 10.1111/j.1753-6405.2012.00882.x Epub 2012 Jun 28. PMID: . PubMed DOI

Schaal NK, Hepp P, Heil M, Wolf OT, Hagenbeck C, Fleisch M, et al.. Perioperative anxiety and length of hospital stay after caesarean section—A cohort study. Eur J Obstet Gynecol Reprod Biol. 2020. May;248:252–256. doi: 10.1016/j.ejogrb.2020.03.045 Epub 2020 Mar 28. PMID: . PubMed DOI

OECD. Health Care Utilisation: Hospital average length of stay: Single spontaneous delivery. [cited 2022 June 17]. Available from: https://stats.oecd.org/

Šťastná A, Slabá J, Kocourková J. [The Planning, Timing, and Factors Behind the Postponement of First Births in the Czech Republic]. Demografie. 2017;59(3): 207–23. Czech.

Kurkin R, Šprocha B, Šídlo L, Kocourková J. Fertility factors in Czechia according to the results of the 2011census. AUC Geographica. 2018;53(2): 137–48. doi: 10.14712/23361980.2018.14 DOI

Šprocha B, Tišliar P, Šídlo L. A cohort perspective on the fertility postponement transition and low fertility in Central Europe. Moravian Geographical Reports. 2018;26(2):109–20. doi: 10.2478/mgr-2018-0009 DOI

Šťastná A, Slabá J, Kocourková J. [Reasons for the unplanned postponement and timing of the birth of a second child]. Demografie 2019;61(2): 77–92. Czech.

Kocourková J. [Reproductive ageing of the Czech population]. Gynekologie a porodnictví. 2018; 2(1): 4–7. Czech.

Czech Statistical Office. [Demographic Yearbook of the Czech Republic– 2019] [cited 2021 May 20]. Czech. Available from: https://www.czso.cz/csu/czso/demograficka-rocenka-ceske-republiky-2019.

Ministry of Health of the Czech Republic. [Perinatology centers in the Czech Republic]. Bulletin of the Ministry of Health of the Czech Republic. 2014; 2: 5–16 [cited 2022 July 07]. Czech. Available from: https://www.mzcr.cz/wp-content/uploads/wepub/9030/36169/V%C4%9Bstn%C3%ADk%20MZ%20%C4%8CR%202-2014.pdf.

Section of Perinatology and Fetomaternal Medicine. [Perinatology centers] [cited 2022 July 07]. Czech. Available from: https://www.perinatologie.eu/pracoviste/.

Czechia. [Government Regulation on local and time availability of health services]. Government Regulation No. 307/2012 Coll. [cited 2022 June 20]. Czech. Available from: https://www.zakonyprolidi.cz/cs/2012-307.

Galková G, Böhm P, Hon Z, Heřman T, Doubrava R, Navrátil L. Comparison of the Frequency of Home Births in the Member States of the EU Between 2015 and 2019. Glob. Pediatr. Health. 2022;9. doi: 10.1177/2333794X211070916 PubMed DOI PMC

General Health Insurance Company of the Czech Republic (GHIC CR). Sorted anonymised individual data provided on the basis of an application for the purpose of a grant project. Czech. Non-public data file. Prague: GHIC, 2017.

General Health Insurance Company of the Czech Republic (GHIC CR). [Yearbook of the General Health Insurance Company of the Czech Republic for the year 2014] [cited 2022 June 18]. Czech. Available from: https://media.vzpstatic.cz/media/Default/dokumenty/rocenka-2014.pdf

Czechia. [Act of the Czech National Council on the General Health Insurance Fund of the Czech Republic]. Act No. 551/1991 Coll. [cited 2022 June 20]. Czech. Available from: https://www.zakonyprolidi.cz/cs/1991-551.

Institute of Health Information and Statistics of the Czech Republic. [Mother and newborn 2014–2015]. The Institute of Health Information and Statistics of the Czech Republic; 2015 [cited 2021 May 20]. Czech. Available from: https://www.uzis.cz/sites/default/files/knihovna/rodnov2014_2015.pdf.

Pavlík T, Bartůňková M, Bortlíček Z et al.. [Methodology for calculating relative weights in the CZ-DRG systém]. Methodological material of the DRG Restart project. The Institute of Health Information and Statistics of the Czech Republic; 2018, version 2, 17 p. [cited 2021 Jul 10] Czech. Available from: https://drg.uzis.cz/res/file/metodiky/cz-drg-metodika-vypoctu-relativnich-vah-2018.pdf.

Schorr E. Theoretical framework for determining hospital length of stay (LOS). BMC Proc. 2012. Jul 9;6(Suppl 4):P32. doi: 10.1186/1753-6561-6-S4-P32 PMCID: PMC3426085. DOI

Roztočil A, Calda P. [Recommended care in the physiological puerperium]. Ceska Gynekol 2013; 78(Supplementum): 51. Czech.

Mydlilová A. [Breastfeeding of newborns]. Ceska Gynekol 2013; 78(Supplementum): 95–97. Czech.

Waldaufová E, Šťastná A. [The role of reproductive ageing in the insrease in caesarean births in Czechia]. Demografie 2022; 64(2): 91–105. doi: 10.54694/dem.0296 Czech. DOI

Kocourková J, Burcin B, Kučera T. Demographic relevancy of increased use of assisted reproduction in European countries. Reprod Health. 2014. May 26;11:37. doi: 10.1186/1742-4755-11-37 ; PMCID: PMC4049397. PubMed DOI PMC

Pison G, Monden C, Smits J. Twinning Rates in Developed Countries: Trends and Explanations. Population and Development Review. 2015; 41(4): 629–649. doi: 10.1111/j.1728-4457.2015.00088.x DOI

Havelková T, Šídlo L, Kocourková J, Šťastná A. [Mothers and their new-born children in Czechia in 2014: Hospitalisation costs associated with the birth of a child with regard to the probable way of conceiving a child]. Demografie 2021, 63(3): 173–186. Czech.

Oyetunji A, Chandra P. Postpartum stress and infant outcome: A review of current literature. Psychiatry Res. 2020 Feb;284:112769. doi: 10.1016/j.psychres.2020.112769 Epub 2020 Jan 9. PMID: . PubMed DOI

Webb R, Ayers S, Bogaerts A, Jeličić L, Pawlicka P, Van Haeken S, et al.. When birth is not as expected: a systematic review of the impact of a mismatch between expectations and experiences. BMC Pregnancy Childbirth. 2021. Jul 2;21(1):475. doi: 10.1186/s12884-021-03898-z ; PMCID: PMC8252193. PubMed DOI PMC

Vossbeck-Elsebusch AN, Freisfeld C, Ehring T. Predictors of posttraumatic stress symptoms following childbirth. BMC Psychiatry. 2014. Jul 16;14:200. doi: 10.1186/1471-244X-14-200 ; PMCID: PMC4223528. PubMed DOI PMC

Hamacher D, Törpel A, Hamacher D, Schega L. The effect of physical exhaustion on gait stability in young and older individuals. Gait Posture. 2016. Jul;48:137–139. doi: 10.1016/j.gaitpost.2016.05.007 Epub 2016 May 18. PMID: . PubMed DOI

Woolhouse H, Perlen S, Gartland D, Brown SJ. Physical health and recovery in the first 18 months postpartum: does cesarean section reduce long-term morbidity? Birth. 2012. Sep;39(3):221–9. doi: 10.1111/j.1523-536X.2012.00551.x Epub 2012 Jul 3. PMID: . PubMed DOI

Evans K, Fraser H, Uthman O, Osokogu O, Johnson S, Al-Khudairy L. The effect of mode of delivery on health-related quality-of-life in mothers: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2022. Feb 22;22(1):149. doi: 10.1186/s12884-022-04473-w ; PMCID: PMC8864819. PubMed DOI PMC

Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. 1987;65(5):663–737. PMID: ; PMCID: PMC2491072. PubMed PMC

Digenis C, Salter A, Cusack L, Koch A, Turnbull D. Reduced length of hospital stay after caesarean section: A systematic review examining women’s experiences and psychosocial outcomes. Midwifery. 2020 Dec;91:102855. doi: 10.1016/j.midw.2020.102855 Epub 2020 Oct 3. PMID: . PubMed DOI

Gunnarsdottir J, Bjornsdottir TE, Halldorsson TI, Halldorsdottir G, Geirsson RT. [Shortened hospital stay for elective cesarean section after initiation of a fast-track program and midwifery home-care]. Laeknabladid. 2011. Jul;97(07):407–12. Icelandic. doi: 10.17992/lbl.2011.0708.380 . PubMed DOI

Wen SW, Liu S, Marcoux S, Fowler D. Trends and variations in length of hospital stay for childbirth in Canada. CMAJ. 1998. Apr 7;158(7):875–80. PMID: ; PMCID: PMC1229182. PubMed PMC

Wen T, Yu VX, Wright JD, Goffman D, Attenello F, Mack WJ, et al.. Postpartum length of stay and risk for readmission among women with preeclampsia. J Matern Fetal Neonatal Med. 2020. Apr;33(7):1086–1094. doi: 10.1080/14767058.2018.1514382 Epub 2018 Sep 10. PMID: ; PMCID: PMC6380960. PubMed DOI PMC

Koyuncu K, Turgay B, Şükür YE, Yıldırım B, Ateş C, Söylemez F. Third trimester anemia extends the length of hospital stay after delivery. Turk J Obstet Gynecol. 2017. Sep;14(3):166–169. doi: 10.4274/tjod.87864 Epub 2017 Sep 30. PMID: ; PMCID: PMC5651891. PubMed DOI PMC

Mamun AA, Callaway LK, O’Callaghan MJ, Williams GM, Najman JM, Alati R, et al.. Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. BMC Pregnancy Childbirth. 2011. Sep 6;11:62. doi: 10.1186/1471-2393-11-62 ; PMCID: PMC3178538. PubMed DOI PMC

Hájek Z, Čech E, Maršál K. et al.. Porodnictví [Obstetrics]. Praha: Grada; 2014. Czech.

Vlachová T., Kocourková J, Fait T. [Advance maternal age–risk factor for low birhtweight]. Ceska Gynekol 2018; 83(5): 337–340. Czech. PubMed

Feasible Influence of G-CSF on Clinical Pregnancy Outcome in Oocyte Donation Cycles for Patients with Recurrent Implantation Failure