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Wilson JM, He J, Flowers KM, Kovacheva V, Soens M, Schreiber KL. Pain Severity and Pain Interference in Late Pregnancy: An Analysis of Biopsychosocial Factors Among Women Scheduled for Cesarean Delivery. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:652-660. [PMID: 36331346 PMCID: PMC10233490 DOI: 10.1093/pm/pnac171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2023]
Abstract
OBJECTIVE Pain is a variably experienced symptom during pregnancy, and women scheduled for cesarean delivery, an increasingly common procedure, are a relatively understudied group who might be at higher pain risk. Although biopsychosocial factors are known to modulate many types of chronic pain, their contribution to late pregnancy pain has not been comprehensively studied. We aimed to identify biopsychosocial factors associated with greater pain severity and interference during the last week of pregnancy. METHODS In this prospective, observational study, 662 pregnant women scheduled for cesarean delivery provided demographic and clinical information and completed validated psychological and pain assessments. Multivariable hierarchical linear regressions assessed independent associations of demographic, clinical, and psychological characteristics with pain severity and pain interference during the last week of pregnancy. RESULTS Women in the study had a mean age of 34 years, and 73% identified as White, 11% as African American, 10% as Hispanic/Latina, and 6% as Asian. Most women (66%) were scheduled for repeat cesarean delivery. Significant independent predictors of worse pain outcomes included identifying as African American or Hispanic/Latina and having greater depression, sleep disturbance, and pain catastrophizing. Exploratory analyses showed that women scheduled for primary (versus repeat) cesarean delivery reported higher levels of anxiety and pain catastrophizing. CONCLUSIONS Independent of demographic or clinical factors, psychological factors, including depression, sleep disturbance, and pain catastrophizing, conferred a greater risk of late pregnancy pain. These findings suggest that women at higher risk of pain during late pregnancy could benefit from earlier nonpharmacological interventions that concurrently focus on psychological and pain symptoms.
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Affiliation(s)
- Jenna M Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jingui He
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vesela Kovacheva
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mieke Soens
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Comfort L, Jain M, Wu H, Nathan L. Rate of Primary Cesarean Delivery by Language Preference among Nulliparas. Am J Perinatol 2023. [PMID: 36608699 DOI: 10.1055/a-2008-8540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Sociodemographic factors such as race/ethnicity and socioeconomic status affect primary cesarean delivery rates. Language is associated with disparate health care outcomes but has not been well studied in obstetrics. We examined the association between primary unscheduled cesarean delivery rate and preferred patient language. STUDY DESIGN A retrospective cohort study was conducted at an urban medical center between January 2017 and January 2020. Nulliparous women with early or full-term gestation and having no obstetric or medical contraindication to vaginal delivery were included. We used multivariable linear and logistic regressions to evaluate language differences in cesarean delivery odds and indication for cesarean. RESULTS Of the 1,314 eligible women, 76.8% of patients preferred English, 17.8% Spanish, and 5.4% other languages. Overall cesarean delivery rate was 27.6%. Controlling for age, race/ethnicity, body mass index, insurance, gravidity, pregnancy comorbidities, labor induction, and infant birth weight, Spanish- and other language-speaking women had significantly higher odds of undergoing cesarean compared with English-speaking women (adjusted odds ratio [OR]: 1.75; 95% confidence interval [CI]: 1.25, 2.46). Relative proportions of indications for cesarean did not differ by language group. Documented interpreter use was an effect modifier on the relationship between language preference and cesarean (OR with interpreter use: 2.89, 95% CI: 1.90, 4.39). CONCLUSION Primary cesarean delivery rates were significantly higher among nulliparous women who prefer languages other than English. This difference may reflect lack of communication, provider bias or discrimination, or other factors, and should be further studied. Interpreter services should be routinely utilized and documented effectively. KEY POINTS · Women who prefer languages other than English had higher odds of cesarean.. · Indication for cesarean did not differ by language.. · Interpreter use did not reduce risk for cesarean..
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Affiliation(s)
- Lizelle Comfort
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Meaghan Jain
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Haotian Wu
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Lisa Nathan
- Department of Obstetrics, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
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Agunwamba AA, Finney Rutten LJ, St Sauver JL, Agunwamba AO, Jacobson DJ, McGree ME, Njeru JW. Higher Rates of Cesarean Sections Found in Somali Immigrant Women in Minnesota. J Racial Ethn Health Disparities 2022; 9:1765-1774. [PMID: 34309817 PMCID: PMC9550004 DOI: 10.1007/s40615-021-01113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare prenatal characteristics and postpartum outcomes among Somali and non-Somali women residing in Olmsted County. METHODS We reviewed the medical records for a cohort of Somali women (≥18 years old; N= 298) who had singleton births between January 2009 and December 2014 and for an age-matched non-Somali cohort (N= 298) of women residing in Olmsted County, Minnesota. Logistic regression models which accounted for repeated measures were used to assess differences in prenatal and postpartum outcomes between Somali and non-Somali women. RESULTS Somali women had a significantly higher odds of cesarean section (adjusted OR=1.81; 95% CI=1.15, 2.84). Additionally, Somali women had a significantly lower odds of postpartum depression (adjusted OR=0.27; 95% CI=0.12, 0.63). CONCLUSION The reported adverse postpartum outcomes have implications for interventions aimed at addressing perinatal care disparity gaps for Somali women immigrant and refugee populations.
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Affiliation(s)
- Amenah A Agunwamba
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA.
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA
| | | | | | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Brazier E, Borrell LN, Huynh M, Kelly EA, Nash D. Variation and racial/ethnic disparities in Caesarean delivery at New York City hospitals: The contribution of hospital-level factors. Ann Epidemiol 2022; 73:1-8. [PMID: 35728734 DOI: 10.1016/j.annepidem.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE We aimed to quantify general and specific contextual effects associated with Caesarean delivery at New York City (NYC) hospitals, overall and by maternal race/ethnicity. METHODS Among 127,449 singleton, nulliparous births at NYC hospitals from 2015 to 2017, we used multilevel logistic regression to examine the association of hospital characteristics (public/private ownership, teaching status and delivery caseloads) with Caesarean delivery, overall, and by maternal race/ethnicity. We estimated the intra-class correlation (ICC) to examine general contextual effects and 80% interval odds ratios (IOR) and percentage of opposed odds ratios (POOR) to examine specific contextual effects. RESULTS Overall, 27.8% of births were Caesareans. The general contextual (hospital) effect on Caesarean delivery was small (ICC: 1.8%). Hospital characteristics associated with Caesarean delivery differed by maternal race/ethnicity, with delivery in teaching hospitals reducing the odds of Caesarean delivery among White (IOR: 0.31, 0.86; POOR: 4.7%) and Asian women (IOR: 0.41, 0.95; POOR: 7.3%), but not among Black (IOR: 0.51, 1.34; POOR: 30.7%) or Hispanic women (IOR: 0.44, 1.24; POOR: 22.6%). Hospital ownership and caseloads were not associated with Caesarean delivery for any group. CONCLUSION There is little within-hospital clustering of Caesarean delivery, suggesting that Caesarean disparities may not be explained by hospital of delivery.
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Affiliation(s)
- Ellen Brazier
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY; Department of Epidemiology & Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY.
| | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY
| | - Mary Huynh
- Office of Vital Statistics, Bureau of Vital Statistics, NYC Department of Health and Mental Hygiene, New York, NY
| | - Elizabeth A Kelly
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY; Department of Epidemiology & Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY
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Erickson EN, Carlson NS. Maternal Morbidity Predicted by an Intersectional Social Determinants of Health Phenotype: A Secondary Analysis of the NuMoM2b Dataset. Reprod Sci 2022; 29:2013-2029. [PMID: 35312992 DOI: 10.1007/s43032-022-00913-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/05/2022] [Indexed: 12/24/2022]
Abstract
Maternal race, ethnicity and socio-economic position are known to be associated with increased risk for a range of poor pregnancy outcomes, including maternal morbidity and mortality. Previously, researchers seeking to identify the contributing factors focused on maternal behaviors and pregnancy complications. Less understood is the contribution of the social determinants of health (SDoH) in observed differences by race/ethnicity in these key outcomes. In this secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset, latent mixture modeling was used to construct groups of healthy, nulliparous participants with a non-anomalous fetus in a cephalic presentation having a trial of labor (N = 5763) based on SDoH variables. The primary outcome was a composite score of postpartum maternal morbidity. A postpartum maternal morbidity event was experienced by 350 individuals (6.1%). Latent class analysis using SDoH variables revealed six groups of participants, with postpartum maternal morbidity rates ranging from 8.7% to 4.5% across groups (p < 0.001). Two SDoH groups had the highest odds for maternal morbidity. These higher-risk groups were comprised of participants with the lowest income and highest stress and those who had lived in the USA for the shortest periods of time. SDoH phenotype predicted MM outcomes and identified two important, yet distinct groups of pregnant people who were the most likely have a maternal morbidity event.
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Affiliation(s)
- Elise N Erickson
- Oregon Health & Sciences University School of Nursing, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Nicole S Carlson
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
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Racial and Ethnic Inequities in Cesarean Birth and Maternal Morbidity in a Low-Risk, Nulliparous Cohort. Obstet Gynecol 2022; 139:73-82. [PMID: 34856577 PMCID: PMC8678297 DOI: 10.1097/aog.0000000000004620] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate race and ethnicity differences in cesarean birth and maternal morbidity in low-risk nulliparous people at term. METHODS We conducted a secondary analysis of a randomized trial of expectant management compared with induction of labor in low-risk nulliparous people at term. The primary outcome was cesarean birth. Secondary outcome was maternal morbidity, defined as: transfusion of 4 or more units of red blood cells, any transfusion of other products, postpartum infection, intensive care unit admission, hysterectomy, venous thromboembolism, or maternal death. Multivariable modified Poisson regression was used to evaluate associations between race and ethnicity, cesarean birth, and maternal morbidity. Indication for cesarean birth was assessed using multivariable multinomial logistic regression. A mediation model was used to estimate the portion of maternal morbidity attributable to cesarean birth by race and ethnicity. RESULTS Of 5,759 included participants, 1,158 (20.1%) underwent cesarean birth; 1,404 (24.3%) identified as non-Hispanic Black, 1,670 (29.0%) as Hispanic, and 2,685 (46.6%) as non-Hispanic White. Adjusted models showed increased relative risk of cesarean birth among non-Hispanic Black (adjusted relative risk [aRR] 1.21, 95% CI 1.03-1.42) and Hispanic (aRR 1.26, 95% CI 1.08-1.46) people compared with non-Hispanic White people. Maternal morbidity affected 132 (2.3%) individuals, and was increased among non-Hispanic Black (aRR 2.05, 95% CI 1.21-3.47) and Hispanic (aRR 1.92, 95% CI 1.17-3.14) people compared with non-Hispanic White people. Cesarean birth accounted for an estimated 15.8% (95% CI 2.1-48.7%) and 16.5% (95% CI 4.0-44.0%) of excess maternal morbidity among non-Hispanic Black and Hispanic people, respectively. CONCLUSION Non-Hispanic Black and Hispanic nulliparous people who are low-risk at term undergo cesarean birth more frequently than low-risk non-Hispanic White nulliparous people. This difference accounts for a modest portion of excess maternal morbidity.
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Spurlock EJ, Kue J, Gillespie S, Ford J, Ruiz RJ, Pickler RH. Integrative Review of Disparities in Mode of Birth and Related Complications among Mexican American Women. J Midwifery Womens Health 2021; 67:95-106. [PMID: 34958159 DOI: 10.1111/jmwh.13288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cesarean rates are particularly high among Hispanic women in some regions of the United States, placing a disproportionate health burden on women and their newborns. This integrative review synthesized the literature on mode of birth (vaginal vs cesarean) and related childbirth complications (hemorrhage, surgical site infection, perineal trauma) among Mexican American women living in the United States. METHODS Four electronic databases, PubMed, Embase, CINAHL, and SCOPUS, were searched to identify studies meeting the inclusion criteria, research studies that included Mexican American women who were pregnant or postpartum. Results were limited to English language and publications that were peer-reviewed and published before May 2020. Covidence was used in article identification, screening, and assessment. Critical appraisal of the research was performed using the Quality Assessment Tool for Studies with Diverse Designs. RESULTS Ten articles met inclusion criteria. In some studies, Mexican American women born in the United States were more likely to have cesareans than women born in Mexico; in other studies, these findings were reversed. Mexican American women often had lower unadjusted cesarean rates compared with non-Hispanic white women, but adjusting for birth facility (some facilities perform more cesareans than others), sociodemographic, and risk factors often revealed Mexican American women have a higher adjusted risk for cesarean birth. Women with higher socioeconomic status had higher cesarean rates compared with women with lower socioeconomic status. In studies of birth outcome by level of acculturation, women who were US-oriented had higher rates of cesarean and more frequent perinatal complications. By ethnic subgroup, rates of cesarean and complications varied among Hispanic women. DISCUSSION Birth facility was associated with perinatal outcomes for Mexican American women; those who gave birth at higher-performing facilities had better outcomes when compared with women who gave birth at lower-performing facilities. After adjusting for pregnancy complications, Mexican American women had a greater risk for cesarean birth compared with non-Hispanic white women, a finding that may have clinical practice implications. Level of acculturation affected birth outcomes, but more research using precise instruments is needed.
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Affiliation(s)
| | - Jennifer Kue
- College of Nursing, University of South Florida, Tampa, Florida
| | | | - Jodi Ford
- College of Nursing, The Ohio State University, Columbus, Ohio
| | | | - Rita H Pickler
- College of Nursing, The Ohio State University, Columbus, Ohio
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Valdes EG. Examining Cesarean Delivery Rates by Race: a Population-Based Analysis Using the Robson Ten-Group Classification System. J Racial Ethn Health Disparities 2021; 8:844-851. [PMID: 32808193 PMCID: PMC8285304 DOI: 10.1007/s40615-020-00842-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/10/2020] [Accepted: 08/04/2020] [Indexed: 12/29/2022]
Abstract
The Robson Ten-Group Classification System is widely considered to be the gold standard for comparing cesarean section (CS) delivery rates, despite limited adoption in the United States (US). When reporting overall CS rates, Blacks and other minorities are typically reported to have high CS rates but comparing overall CS rates may be misleading as CS may be more common in some higher risk populations. Improved understanding of how CS rates differ by race among standardized groups could highlight differences in care and areas for improvement. The current study examines racial differences in cesarean section delivery rates using the Robson Ten-Group Classification System in a nationwide sample. Data from US vital statistics live birth certificates were used to identify 3,906,088 births which were each classified into one of the ten groups based on five obstetric characteristics identifiable on presentation for delivery including parity, onset of labor, gestational age, fetal presentation, and number of fetuses. Results indicated that Black and Asian mothers had the highest CS rates in groups 1-4 which all contain single, cephalic pregnancies at term with no prior CS and are only differentiated by parity and onset of labor. Black mothers also had the lowest CS rates for groups 6 and 7, containing women with nulliparous and multiparous breech births. Black and Asian mothers show differences in CS rates among groups that could indicate lack of appropriate care. Efforts should be made to prevent unnecessary primary CS among low-risk mothers.
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Affiliation(s)
- Elise G Valdes
- Relias LLC, Relias Institute, 1010 Sync St., Morrisville, NC, 27560, USA.
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Poncet L, Panjo H, Andro A, Ringa V. Caesarean delivery in a migration context: the role of prior delivery in the host country. Sex Reprod Health Matters 2021; 28:1763576. [PMID: 32544031 PMCID: PMC7888083 DOI: 10.1080/26410397.2020.1763576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Migrant women in industrialised countries experience high caesarean section (CS) rates but little is known about the effect of a previous delivery in the host country. This study set out to investigate this effect among migrant women in France, using data from the DSAFHIR study on healthcare access of migrant women living in emergency housing hotels, collected in the Paris Metropolitan area in 2017. Respondents reported life-long history of deliveries. We focused on deliveries occurring in France in 2000–2017: 370 deliveries reported by 242 respondents. We conducted chi-square tests and multivariate logistic regressions, adjusting for the clustering of deliveries among respondents by computing standard errors allowing for intragroup correlation. Mode of delivery was associated with duration of residence among multiparous women with no prior CS, with a higher CS rate with shorter duration of residence (16% vs. 7%, p = 0.04). In this group, a previous delivery in France was associated with a lower CS rate (5% vs. 16%, p = 0.008). In multivariate analysis, compared with women with previous birth in France, women giving birth in France for the first time had a higher risk of CS, regardless of duration of residence (aOR = 4.0, 95% CI = 1.3–12.1 for respondents with short duration of residence, aOR = 4.7, 95% CI = 1.2–18.0 for respondents with longer duration of residence). Efforts directed at decreasing the CS rate among migrant women should target women giving birth in the host country for the first time.
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Affiliation(s)
- Lorraine Poncet
- PhD Candidate in Public Health, Université Paris-Saclay (INSERM), UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France; French Collaborative Institute on Migration, Paris, France
| | - Henri Panjo
- Research Engineer, Université Paris-Saclay (INSERM), UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France
| | - Armelle Andro
- Professor, Institute of Demography, Université Paris I Pantheon-Sorbonne, Paris, France; French Collaborative Institute on Migration, Paris, France
| | - Virginie Ringa
- Researcher (INSERM), Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France
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Schaefer KM, Modest AM, Hacker MR, Chie L, Connor Y, Golen T, Molina RL. Language Preference and Risk of Primary Cesarean Delivery: A Retrospective Cohort Study. Matern Child Health J 2021; 25:1110-1117. [PMID: 33904024 DOI: 10.1007/s10995-021-03129-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES While some medical indications for cesarean delivery are clear, subjective provider and patient factors contribute to the rising cesarean delivery rates and marked disparities between racial/ethnic groups. We aimed to determine the association between language preference and risk of primary cesarean delivery. METHODS We conducted a retrospective cohort study of nulliparous, term, singleton, vertex (NTSV) deliveries of patients over 18 years old from 2011-2016 at an academic medical center, supplemented with data from the Massachusetts Department of Public Health. We used modified Poisson regression with robust error variance to calculate risk ratios for cesarean delivery between patients with English language preference and other language preference, with secondary outcomes of Apgar score, maternal readmission, blood transfusion, and NICU admission. RESULTS Of the 11,298 patients included, 10.3% reported a preferred language other than English, including Mandarin and Cantonese (61.7%), Portuguese (9.7%), and Spanish (7.5%). The adjusted risk ratio for cesarean delivery among patients with a language preference other than English was 0.85 (95% CI 0.72-0.997; p = 0.046) compared to patients with English language preference. No significant differences in risk of secondary outcomes between English and other language preference were found. DISCUSSION After adjusting for confounders, this analysis demonstrates a decreased risk of cesarean delivery among women who do not have an English language preference at one institution. This disparity in cesarean delivery rates in an NTSV population warrants future research, raising the question of what clinical and social factors may be contributing to these lower cesarean delivery rates.
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Affiliation(s)
| | - Anna M Modest
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Michele R Hacker
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Lucy Chie
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Yamicia Connor
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Toni Golen
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Rose L Molina
- Harvard Medical School, Boston, MA, USA.
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA.
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Attanasio LB, Paterno MT. Racial/Ethnic Differences in Socioeconomic Status and Medical Correlates of Trial of Labor After Cesarean and Vaginal Birth After Cesarean. J Womens Health (Larchmt) 2021; 30:1788-1794. [PMID: 33719567 DOI: 10.1089/jwh.2020.8801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Black and Latinx women have higher rates of trial of labor after cesarean (TOLAC) compared with White women, but lower rates of vaginal birth after cesarean (VBAC). This study examined potential racial/ethnic differences in correlates of TOLAC and VBAC. Materials and Methods: The analytic sample includes term, singleton hospital births to women with one prior cesarean in birth certificate data for 2016. We estimated associations between medical factors (diabetes, hypertension, and prepregnancy obesity) and socioeconomic status (education level and insurance type) and TOLAC and VBAC using logistic regression, stratifying by race/ethnicity and testing whether coefficients differed across models. Results: Hypertension and obesity were more strongly related to reduced chances of TOLAC among White women than among women of color. For example, having a body mass index (BMI) between 30 and 39 (vs. normal BMI) was associated with a 6.3 percentage-point (pp) lower probability of TOLAC for White women, a 5.9 pp lower probability for Black women, and 2.9 pp lower probability for Latinx women. Paying out-of-pocket for birth was associated with a 5.5 pp increase in the probability of TOLAC among White women, versus a 3.2 pp decrease among Black women. Overweight and obesity were associated with lower probability of VBAC, but the magnitude of this association was smaller for Black and Latinx women than for White women. Conclusions: More research is needed to elucidate the underlying decision-making processes that lead to these associations. Future work should focus on ensuring equity in access to VBAC-supportive providers and hospitals and fostering informed decision-making after a prior cesarean.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts, USA
| | - Mary T Paterno
- Cooley Dickinson Women's Health, Northampton, Massachusetts, USA
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Melero V, García de la Torre N, Assaf-Balut C, Jiménez I, del Valle L, Durán A, Bordiú E, Valerio JJ, Herraiz MA, Izquierdo N, Torrejón MJ, Runkle I, Barabash A, Rubio MA, Calle-Pascual AL. Effect of a Mediterranean Diet-Based Nutritional Intervention on the Risk of Developing Gestational Diabetes Mellitus and Other Maternal-Fetal Adverse Events in Hispanic Women Residents in Spain. Nutrients 2020; 12:nu12113505. [PMID: 33202607 PMCID: PMC7696021 DOI: 10.3390/nu12113505] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is the most frequent morbidity found in pregnancy, and it increases the risk for several maternal-fetal complications. Hispanic women are considered at high risk. The St. Carlos GDM prevention study is a randomized controlled trial (RCT) conducted from 2016–2017. Normoglycemic women were randomized at 12–14 Gestation week (WG) to an intervention group (IG) receiving recommendations based on the MedDiet (supplemented with ExtraVirgin Olive Oil/pistachios), or to a control group (CG), recommended to limit fat intake. After RCT conclusion, IG recommendations were applied to a real-world group (RW) in routine clinical practice. The primary endpoint of the current study is an assessment of the GDM rate in Hispanic participants of the aforementioned studies: 132 RCT, 128 CT, 284 RW participants. The GDM rate was lower in IG: 19/128(14.8%), p = 0.021, and RW: 38/284(13.4%), p = 0.029) than in CG: 34/132(25.8%). Adjusted RR (95%CI) for GDM: 0.72 (0.50–0.97), p = 0.037 in IG and 0.77 (0.61–0.97), p = 0.008 in RW. Rates of urinary tract infections, emergency caesarean-sections and perineal trauma were also lower in IG and RW. Other adverse outcomes were lower in IG vs. CG. In conclusion, a MedDiet-based intervention reduces the rate of GDM and several adverse maternal-fetal outcomes in Hispanic women residing in Spain.
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Affiliation(s)
- Verónica Melero
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
| | - Nuria García de la Torre
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E 28040 Madrid, Spain
| | - Carla Assaf-Balut
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
| | - Inés Jiménez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
| | - Laura del Valle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
| | - Alejandra Durán
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Elena Bordiú
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Johanna J. Valerio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Miguel A Herraiz
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain
| | - Nuria Izquierdo
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
- Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain;
| | - Maria José Torrejón
- Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain;
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Ana Barabash
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E 28040 Madrid, Spain
| | - Miguel A Rubio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
| | - Alfonso L Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), E 28040 Madrid, Spain; (V.M.); (N.G.d.l.T.); (C.A.-B.); (I.J.); (L.d.V.); (A.D.); (E.B.); (J.J.V.); (I.R.); (A.B.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E 28040 Madrid, Spain
- Medicina 2 Department, Facultad de Medicina, Universidad Complutense de Madrid, E 28040 Madrid, Spain; (M.A.H.); (N.I.)
- Correspondence: ; Tel.: +34-91-330-3281; Fax: +34-91-330-3240
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Vanderlaan J, Edwards JA, Dunlop A. Geospatial variation in caesarean delivery. Nurs Open 2020; 7:627-633. [PMID: 32089861 PMCID: PMC7024620 DOI: 10.1002/nop2.433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/24/2019] [Accepted: 11/25/2019] [Indexed: 11/15/2022] Open
Abstract
Aim The purpose of this study was to evaluate the variation in caesarean delivery rates across counties in Georgia and to determine whether county-level characteristics were associated with clusters. Design This was a retrospective, observational study. Methods Rates of primary and repeat caesarean by maternal county of residence were calculated for 2008 through 2012. Global Moran's I (Spatial Autocorrelation) was used to identify geographic clustering. Characteristics of high and low-rate counties were compared using student's t test and chi-squared test. Results Spatial analysis of both primary and repeat caesarean rate identified the presence of clusters (Moran's I = 0.375; p < .001). Counties in high-rate clusters had significantly lower access to midwives, more deliveries paid by Medicaid, higher proportion of births for women belonging to racial/ethnic minority groups and were more likely to be rural.
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Affiliation(s)
| | - Johnathan A. Edwards
- Department of Biomedical InformaticsEmory University School of MedicineAtlantaGA
| | - Anne Dunlop
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGA
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Glazer KB, Danilack VA, Werner EF, Field AE, Savitz DA. Elucidating the role of overweight and obesity in racial and ethnic disparities in cesarean delivery risk. Ann Epidemiol 2020; 42:4-11.e4. [PMID: 32005568 DOI: 10.1016/j.annepidem.2019.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 09/16/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE We aimed to quantify the extent to which overweight and obesity explain cesarean delivery risk among women of different racial and ethnic backgrounds. METHODS Using administrative records for 216,481 singleton, nulliparous births in New York City from 2008 to 2013, we calculated risk ratios, risk differences, and population attributable fractions for associations between body mass index (BMI) and cesarean, stratified by race and ethnicity. RESULTS The population attributable fraction (95% confidence interval) for BMI was 6.8% (6.2%-7.3%) among Asian, 10.9% (10.4%-11.4%) among White, 14.6% (13.7%-15.5%) among Hispanic, and 17.4% (16.2%-18.6%) among Black women. Although overweight and obesity were most prevalent among Black and Hispanic women, the risk gradient was strongest among Whites (adjusted risk ratio [95% CI] from 1.37 [1.33-1.41] for overweight to 2.23 [2.07-2.39] for class III obesity). Additional adjustment for gestational complications partially attenuated associations, and accounting for delivery hospital eliminated the stronger gradient among White women. CONCLUSIONS Prepregnancy overweight and obesity contribute proportionally more to cesarean risk among Black and Hispanic women because of higher prevalence compared to White or Asian women. Although preconception weight management is important to decrease cesarean risk, results encourage attention to clinical approaches in low-risk pregnancies to mitigate racial and ethnic perinatal disparities.
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Affiliation(s)
- Kimberly B Glazer
- Department of Population Health Science and Policy and the Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Epidemiology, Brown University School of Public Health, Providence, RI.
| | - Valery A Danilack
- Department of Population Health Science and Policy and the Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Research, Women & Infants Hospital, Providence, RI; Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Erika F Werner
- Department of Population Health Science and Policy and the Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI; Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI
| | - Alison E Field
- Department of Population Health Science and Policy and the Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Savitz
- Department of Population Health Science and Policy and the Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI
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Mirabal-Beltran R, Strobino DM. Birth Mode after Primary Cesarean among Hispanic and non-Hispanic Women at One U.S. Institution. Womens Health Issues 2020; 30:7-15. [DOI: 10.1016/j.whi.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/26/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Elective delivery (ED) before 39 weeks, low-risk cesarean delivery, and episiotomy are routinely reported obstetric quality measures and have been the focus of quality improvement initiatives over the past decade. OBJECTIVE To estimate trends and differences in obstetric quality measures by race/ethnicity. RESEARCH DESIGN We used 2008-2014 linked birth certificate-hospital discharge data from New York City to measure ED before 39 gestational weeks (ED <39), low-risk cesarean, and episiotomy by race/ethnicity. Measures were following the Joint Commission and National Quality Forum specifications. Average annual percent change (AAPC) was estimated using Poisson regression for each measure by race/ethnicity. Risk differences (RD) for non-Hispanic black women, Hispanic women, and Asian women compared with non-Hispanic white women were calculated. RESULTS ED<39 decreased among whites [AAPC=-2.7; 95% confidence interval (CI), -3.7 to -1.7), while it increased among blacks (AAPC=1.3; 95% CI, 0.1-2.6) and Hispanics (AAPC=2.4; 95% CI, 1.4-3.4). Low-risk cesarean decreased among whites (AAPC=-2.8; 95% CI, -4.6 to -1.0), and episiotomy decreased among all groups. In 2008, white women had higher risk of most measures, but by 2014 incidence of ED<39 was increased among Hispanics (RD=2/100 deliveries; 95% CI, 2-4) and low-risk cesarean was increased among blacks (RD=3/100; 95% CI, 0.5-6), compared with whites. Incidence of episiotomy was lower among blacks and Hispanics than whites, and higher among Asian women throughout the study period. CONCLUSIONS Existing measures do not adequately assess health care disparities due to modest risk differences; nonetheless, continued monitoring of trends is warranted to detect possible emergent disparities.
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Attanasio LB, Kozhimannil KB, Kjerulff KH. Factors influencing women's perceptions of shared decision making during labor and delivery: Results from a large-scale cohort study of first childbirth. PATIENT EDUCATION AND COUNSELING 2018; 101:1130-1136. [PMID: 29339041 PMCID: PMC5977392 DOI: 10.1016/j.pec.2018.01.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/30/2017] [Accepted: 01/04/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine correlates of shared decision making during labor and delivery. METHODS Data were from a cohort of women who gave birth to their first baby in Pennsylvania, 2009-2011 (N = 3006). We used logistic regression models to examine the association between labor induction and mode of delivery in relation to women's perceptions of shared decision making, and to investigate race/ethnicity and SES as potential moderators. RESULTS Women who were Black and who did not have a college degree or private insurance were less likely to report high shared decision making, as well as women who underwent labor induction, instrumental vaginal or cesarean delivery. Models with interaction terms showed that the reduction in odds of shared decision making associated with cesarean delivery was greater for Black women than for White women. CONCLUSIONS Women in marginalized social groups were less likely to report shared decision making during birth and Black women who delivered by cesarean had particularly low odds of shared decision making. PRACTICE IMPLICATIONS Strategies designed to improve the quality of patient-provider communication, information sharing, and shared decision making must be attentive to the needs of vulnerable groups to ensure that such interventions reduce rather than widen disparities.
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Affiliation(s)
- Laura B Attanasio
- Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
| | - Katy B Kozhimannil
- Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences and Department of Obstetrics and Gynecology, College of Medicine, Penn State University, Hershey, PA, USA
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Alamo L, Vial Y, Denys A, Andreisek G, Meuwly JY, Schmidt S. MRI findings of complications related to previous uterine scars. Eur J Radiol Open 2018; 5:6-15. [PMID: 29387735 PMCID: PMC5790820 DOI: 10.1016/j.ejro.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/28/2017] [Accepted: 01/04/2018] [Indexed: 01/23/2023] Open
Abstract
Although the World Health Organization suggests 10–15% as the adequate cesarean delivery rate to assure optimal prognosis for mother and children, cesarean rates have continuously increased worldwide over the last three decades, even in primiparous women. Moreover, uterine scars after myomectomies, complications of obstetrical interventions and more recently, after fetal surgery, are often observed. This review article describes the most commonly seen complications related to prior uterine scars and discusses their imaging findings, with emphasis on the increasing role of Magnetic Resonance Imaging for diagnosis.
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Affiliation(s)
- Leonor Alamo
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL) Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Yvan Vial
- Department of Gynecology and Obstetrics, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL) Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Gustav Andreisek
- Department of Diagnostic Radiology, Institute of Diagnostic and interventional Radiology, University Hospital of Zurich and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Jean-Yves Meuwly
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL) Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL) Rue du Bugnon, 46, 1011, Lausanne, Switzerland
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Liang H, Fan Y, Zhang N, Chongsuvivatwong V, Wang Q, Gong J, Sriplung H. Women's cesarean section preferences and influencing factors in relation to China's two-child policy: a cross-sectional study. Patient Prefer Adherence 2018; 12:2093-2101. [PMID: 30349203 PMCID: PMC6188957 DOI: 10.2147/ppa.s171533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study explored women's preference for cesarean section (CS) and the preference for cesarean sections' influencing factors, particularly nonmedical factors. METHODS A cross-sectional study was conducted in four tertiary hospitals in Hohhot. We recruited 1,169 pregnant women at ≥ 28 gestational weeks and classified subjects into three groups by delivery mode preference: vaginal birth (VB), CS, and "no clear preference". We identified the influencing factors of women's choices by multinomial logistic regression. The adjusted relative-risk ratios (aRRRs) for the factors affecting the preference for CS and "no clear preference" categories and their 95% CIs were computed, using the preference for VB as the reference group. RESULTS VB was preferred by 80.3% of the subjects, 8.8% preferred CS, and 10.9% had not decided yet. In the multinomial logistic regression, pregnant women intending to have more than one child were less likely to prefer CS (aRRR: 0.37; 95% CI: 0.22-0.61); choosing a lucky day for baby birth was the strongest factor for CS preference (aRRR: 12.36; 95% CI: 6.62-23.08), and other factors for CS preference were being aged 40 years and above (aRRR: 4.21; 95% CI: 1.43-12.40), being ethnic minority (aRRR: 2.00; 95% CI: 1.17, 3.41), feeling difficulty in getting pregnant (aRRR: 2.23; 95% CI: 1.20, 4.13), and having husband's preference for CS (aRRR: 7.62; 95% CI: 4.00-14.54). The top reasons for preferring CS were the belief that CS was safer (51.5%), associated with less pain (40.8%), and better for baby's and woman's health (24.3% and 22.3%, respectively). CONCLUSION Less than one-tenth of the study subjects preferred CS. The cultural beliefs had the strongest influence on the decision of delivery mode. Those intending to have two or more children following the two-child policy were less likely to choose CS.
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Affiliation(s)
- Huijuan Liang
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand,
| | - Yancun Fan
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Nan Zhang
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | | | - Qingchun Wang
- Department of Medical Education, Hohhot First Hospital, Hohhot, Inner Mongolia, China
| | - Jing Gong
- Department of Medical Education, Hohhot First Hospital, Hohhot, Inner Mongolia, China
| | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand,
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Attanasio LB, Hardeman RR, Kozhimannil KB, Kjerulff KH. Prenatal attitudes toward vaginal delivery and actual delivery mode: Variation by race/ethnicity and socioeconomic status. Birth 2017; 44:306-314. [PMID: 28887835 PMCID: PMC5687997 DOI: 10.1111/birt.12305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Researchers documenting persistent racial/ethnic and socioeconomic status disparities in chances of cesarean delivery have speculated that women's birth attitudes and preferences may partially explain these differences, but no studies have directly tested this hypothesis. We examined whether women's prenatal attitudes toward vaginal delivery differed by race/ethnicity or socioeconomic status, and whether attitudes were differently related to delivery mode depending on race/ethnicity or socioeconomic status. METHODS Data were from the First Baby Study, a cohort of 3006 women who gave birth to a first baby in Pennsylvania between 2009 and 2011. We used regression models to examine (1) predictors of prenatal attitudes toward vaginal delivery, and (2) the association between prenatal attitudes and actual delivery mode. To assess moderation, we estimated models adding interaction terms. RESULTS Prenatal attitudes toward vaginal delivery were not associated with race/ethnicity or socioeconomic status. Positive attitudes toward vaginal delivery were associated with lower odds of cesarean delivery (AOR=0.60, P < .001). However, vaginal delivery attitudes were only related to delivery mode among women who were white, highly educated, and privately insured. CONCLUSIONS There are racial/ethnic differences in chances of cesarean delivery, and these differences are not explained by birth attitudes. Furthermore, our findings suggest that white and high-socioeconomic status women may be more able to realize their preferences in childbirth.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rachel R Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Katy B Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences and Department of Obstetrics and Gynecology, College of Medicine, Penn State University, Hershey, PA, USA
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Montoya-Williams D, Lemas DJ, Spiryda L, Patel K, Neu J, Carson TL. What Are Optimal Cesarean Section Rates in the U.S. and How Do We Get There? A Review of Evidence-Based Recommendations and Interventions. J Womens Health (Larchmt) 2017; 26:1285-1291. [PMID: 28825512 DOI: 10.1089/jwh.2016.6188] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cesarean sections (CSs) are the most commonly performed surgical procedures in the world today. Global epidemiological studies from the last decade suggest that the optimal CS rates in developed countries exist somewhere between 15% and 19%. Despite these findings, CS rates in the United States have remained stable at slightly over 32% over the past 10 years. Using primary and secondary literature published from 2010 to 2015, this review discusses how optimal CS rates were developed. In addition, we define a category of potentially avoidable CS (i.e., those conducted on nulliparous low-risk women who present with vertex infants at term) and explore how CS in this population appear to be one of the main drivers of high CS rates overall. The institutional, provider, and patient-related factors, which may be related to higher-than-recommended rates of CS, particularly those conducted in low-risk women, will be discussed. This review will then delve into clinician and patient-oriented interventions that have been shown to effectively reduce the rate of potentially avoidable CS. Our analysis showed that large-scale, multifaceted interventions that include audit and feedback cycles as well as peer review strategies were the most effective in decreasing rates of potentially avoidable CS. This review concludes with an agenda for future research into interventions that aim to achieve optimal CS rates.
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Affiliation(s)
- Diana Montoya-Williams
- 1 Division of Neonatology, Department of Pediatrics, University of Florida , Gainesville, Florida
| | - Dominick J Lemas
- 2 Department of Health Outcomes and Policy, University of Florida , Gainesville, Florida
| | - Lisa Spiryda
- 3 Department of Obstetrics and Gynecology, University of Florida , Gainesville, Florida
| | - Keval Patel
- 4 Department of Biology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida
| | - Josef Neu
- 1 Division of Neonatology, Department of Pediatrics, University of Florida , Gainesville, Florida
| | - Tiffany L Carson
- 5 Division of Preventive Medicine, Department of Medicine, University of Alabama , Birmingham, Alabama
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Risk Factors for Shoulder Dystocia: the Impact of Mother's Race and Ethnicity. J Racial Ethn Health Disparities 2017; 5:333-341. [PMID: 28447275 DOI: 10.1007/s40615-017-0374-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/11/2016] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
Shoulder dystocia is a rare but severe birth trauma where the neonate's shoulders fail to deliver after delivery of the head. Failure to deliver the shoulders quickly can lead to severe, long-term injury to the infant, including nerve injury, skeletal fractures, and potentially death. This observational study examined shoulder dystocia risk factors by race and ethnicity using a sample of 19,236 pregnant women who presented for labor and delivery from July 1, 2010 until June 30, 2013 at five locations. Multivariate analyses were used to identify risk factors associated with shoulder dystocia occurrence in racial/ethnic groups with high incidence rates. For White non-Hispanic mothers, the strongest risk factors were delivering past 40 weeks' gestation (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.5, 3.9; p < .01) and use of epidural anesthesia during delivery (OR = 4.4; 95% CI = 3.0, 6.4; p < .01). Among Black non-Hispanic mothers, the risk factors with the greatest impact were use of epidural (OR = 5.3; 95% CI = 3.2, 8.7; p < .01) and having gestational diabetes and controlling the condition with insulin (OR = 4.6; 95% CI = 1.5, 13.8; p < .01). Additionally, among Hispanic mothers, having Spanish as primary language increased shoulder dystocia likelihood compared to those who did not cite it as their primary language (OR = 2.3; 95% CI = 1.1, 4.6; p < .05). This study provides evidence that risk factors for a labor and delivery condition can vary significantly across racial and ethnic subgroups. These differences emphasize the importance of evaluating risk by population subgroups and might provide a basis for labor and delivery clinicians to enhance personalized medicine to reduce adverse events.
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McClelland S, Gorfinkle N, Arslan AA, Benedetto-Anzai MT, Cheon T, Anzai Y. Factors associated with cesarean delivery rates: a single-institution experience. Matern Health Neonatol Perinatol 2017; 3:8. [PMID: 28439421 PMCID: PMC5401466 DOI: 10.1186/s40748-017-0047-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to identify factors associated with variability in Cesarean delivery (CD) rates amongst providers at a single institution. METHODS A retrospective cohort analysis was carried out on all births at NYU Langone Medical Center from 2005-2013. Data was collected for subjects and linked to diagnosis codes for singleton and twin deliveries. Descriptive characteristics were generated for all deliveries, and inferential analysis was performed including multiple covariates for singleton deliveries in the 2010-2013 cohort, including both univariate and multivariate regression analyses to identify factors associated with higher CD rates. RESULTS 37,692 deliveries were identified at our institution during the study period, performed by 88 unique providers. The mean CD rate was 29.6%, with a range for individual physicians from 9.9% to 75.6%. In multivariate regression analysis, CD rate was directly correlated with average patient age, physician male gender, proportion of high-risk deliveries, and Maternal-Fetal Medicine specialty, and it was inversely correlated with total number of deliveries by physician and forceps delivery rate. There was no significant difference in CD rates between group and solo practices. Within the same group practice, each member's CD rate was strongly correlated with the average CD rate of the group. CONCLUSION Our study demonstrates the wide range of CD rates for providers practicing within the same institution and reiterates the association of CD rates with patient age, high-risk pregnancy, and provider volume. Among operative vaginal deliveries, forceps delivery rate was associated with lower CD rates whereas vacuum delivery rate was not. Despite these findings, practice patterns within individual practices appear to contribute significantly to the wide range of CD rates.
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Affiliation(s)
- Spencer McClelland
- NYU Langone Medical Center, Department of Obstetrics and Gynecology, 800 2nd Avenue, Suite 815, New York, NY 10017 USA
| | - Naomi Gorfinkle
- Johns Hopkins University School of Medicine, 4 South Broadway, Baltimore, MD 21231 USA
| | - Alan A. Arslan
- NYU Langone Medical Center, Division of Epidemiology, Departments of Obstetrics and Gynecology, Environmental Medicine, and Population Health, 650 First Ave, Rm. 532, New York, NY 10016 USA
| | - Maria Teresa Benedetto-Anzai
- NYU Langone Medical Center, Department of Obstetrics and Gynecology, 800 2nd Avenue, Suite 815, New York, NY 10017 USA
| | - Teresa Cheon
- NYU Langone Medical Center, Department of Obstetrics and Gynecology, 800 2nd Avenue, Suite 815, New York, NY 10017 USA
| | - Yuzuru Anzai
- NYU Langone Medical Center, Department of Obstetrics and Gynecology, 800 2nd Avenue, Suite 815, New York, NY 10017 USA
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Belihu FB, Small R, Davey MA. Trial of labour and vaginal birth after previous caesarean section: A population based study of Eastern African immigrants in Victoria, Australia. Midwifery 2017; 46:8-16. [PMID: 28104545 DOI: 10.1016/j.midw.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 11/04/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Variations in caesarean section (CS) between some immigrant groups and receiving country populations have been widely reported. Often, African immigrant women are at higher risk of CS than the receiving population in developed countries. However, evidence about subsequent mode of birth following CS for African women post-migration is lacking. The objective of this study was to examine differences in attempted and successful vaginal birth after previous caesarean (VBAC) for Eastern African immigrants (Eritrea, Ethiopia, Somalia and Sudan) compared with Australian-born women. DESIGN A population-based observational study was conducted using the Victorian Perinatal Data Collection. Pearson's chi-square test and logistic regression analysis were performed to generate adjusted odds ratios for attempted and successful VBAC. SETTING Victoria, Australia. PARTICIPANTS 554 Eastern African immigrants and 24,587 Australian-born eligible women with previous CS having singleton births in public care. FINDINGS 41.5% of Eastern African immigrant women and 26.1% Australian-born women attempted a VBAC with 50.9% of Eastern African immigrants and 60.5% of Australian-born women being successful. After adjusting for maternal demographic characteristics and available clinical confounding factors, Eastern African immigrants were more likely to attempt (ORadj 1.94, 95% CI 1.57-2.47) but less likely to succeed (ORadj 0.54 95% CI 0.41-0.71) in having a VBAC. CONCLUSION/IMPLICATIONS FOR PRACTICE There are disparities in attempted and successful VBAC between Eastern African origin and Australian-born women. Unsuccessful VBAC attempt is more common among Eastern African immigrants, suggesting the need for improved strategies to select and support potential candidates for vaginal birth among these immigrants to enhance success and reduce potential complications associated with failed VBAC attempt.
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Affiliation(s)
- Fetene B Belihu
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia.
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia.
| | - Mary-Ann Davey
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia; Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia.
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25
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Wang L, Xu X, Baker P, Tong C, Zhang L, Qi H, Zhao Y. Patterns and Associated Factors of Caesarean Delivery Intention among Expectant Mothers in China: Implications from the Implementation of China's New National Two-Child Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13070686. [PMID: 27399752 PMCID: PMC4962227 DOI: 10.3390/ijerph13070686] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/22/2016] [Accepted: 07/05/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study explores the basic demographic characteristics of expectant mothers in the context of their intentions regarding mode of delivery, in particular, the preference for caesarean delivery, and analyzes the social and psychological factors that influence delivery preference. METHOD A cross-sectional survey of pregnant women was conducted during June to August in 2015. This study adopted a stratified sampling method, and 16 representative hospitals in five provinces of China were included. RESULTS 1755 and 590 of expectant mothers in their first and second pregnancies, respectively, were enrolled in this study. 354 (15.10%) intended to deliver by caesarean section and 585 (24.95%) participants were uncertain prior to delivery. 156 (8.89%) of expectant mothers in their first pregnancy and 198 (33.56%) expectant mothers in their second pregnancy intended to deliver by caesarean section. Ordinal logistic regression analysis found that nationality, parity, trimester of pregnancy, and advanced maternal age were factors associated with intention to deliver by caesarean (ordered logistic regression/three-level caesarean delivery intention criterion; odds ratios p < 0.05). CONCLUSIONS 8.89% of first pregnancy expectant mothers and 33.56% of second pregnancy expectant mothers intended to deliver by caesarean section. Any intervention program to reduce the rate of Caesarean delivery should focus on the Han population, older pregnant women, and expectant mothers in their second pregnancy, at an early gestation.
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Affiliation(s)
- Lianlian Wang
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
- Department of Reproduction Health and Infertility, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
- Canada-China-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing 400016, China.
| | - Xianglong Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Philip Baker
- Canada-China-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing 400016, China.
- College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester 3182, UK.
| | - Chao Tong
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
- Canada-China-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing 400016, China.
| | - Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing 100062, China.
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3182, Australia.
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3053, Australia.
- Melbourne Sexual Health Centre, Alfred Health, Melbourne 3053, Australia.
| | - Hongbo Qi
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
- Canada-China-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing 400016, China.
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China.
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26
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Belihu FB, Small R, Davey MA. Variations in first-time caesarean birth between Eastern African immigrants and Australian-born women in public care: A population-based investigation in Victoria. Aust N Z J Obstet Gynaecol 2016; 57:294-301. [DOI: 10.1111/ajo.12491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Fetene B. Belihu
- Judith Lumley Centre; La Trobe University; Melbourne Vic. Australia
| | - Rhonda Small
- Judith Lumley Centre; La Trobe University; Melbourne Vic. Australia
| | - Mary-Ann Davey
- Judith Lumley Centre; La Trobe University; Melbourne Vic. Australia
- Department of Obstetrics and Gynaecology; Monash University; Clayton Vic. Australia
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Hospital variation in cesarean delivery rates: contribution of individual and hospital factors in Florida. Am J Obstet Gynecol 2016; 214:123.e1-123.e18. [PMID: 26292046 DOI: 10.1016/j.ajog.2015.08.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/16/2015] [Accepted: 08/10/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary cesarean deliveries are a major contributor to the large increase in cesarean delivery rates in the United States over the past 2 decades and are an essential focus for the reduction of related morbidity and costs. Studies have shown that primary cesarean delivery rates among low-risk women in the United States vary 3-fold across hospitals and are not explained by differences in patient case-mix. However, the extent to which maternal vs hospital characteristics contribute to this variation remains poorly understood because previous studies were limited in scope and did not assess the influence of factors such as maternal ethnicity subgroups or prepregnancy obesity. OBJECTIVE We assessed the contribution of individual- and hospital-level risk factors to the hospital variation in primary cesarean delivery rates among low-risk women in Florida. STUDY DESIGN Our population-based retrospective cohort study used Florida's linked birth certificate and hospital discharge records for the period of 2004-2011. The study population was comprised of 412,192 nulliparous, singleton, vertex, live births with labor at 37-40 weeks gestation in 122 nonmilitary delivery hospitals. Data were analyzed with logistic mixed-effects regression with cesarean delivery as the outcome. This approach provided adjusted risk estimates at an individual and hospital level and the estimated percent of hospital variation statewide that was explained by these factors. RESULTS The primary cesarean delivery rate in the study population was 23.9%, with hospital-specific estimates that ranged from 12.8-47.3%. Leading risk factors for cesarean delivery were maternal age ≥35 years (adjusted relative risk, 2.22), prepregnancy obesity (body mass index, ≥30 kg/m(2); adjusted relative risk, 1.73), medical risk conditions (adjusted relative risk, 1.72), labor induction (adjusted relative risk, 1.52), and delivery in hospitals located in Miami-Dade County (adjusted relative risk, 1.73). Hospital geographic location was a significant effect modifier for prepregnancy obesity, medical conditions, and labor induction (P < .05), with a tendency towards lower adjusted relative risks for these factors in Miami-Dade County relative to other Florida regions. Conversely, Miami-Dade County had an increased prevalence of higher-risk ethnic subgroups, such as Cuban or Puerto Rican mothers, and also substantially higher adjusted relative risks that were associated with practice-related factors, such as delivery during weekday hours. Whereas hospital geographic location contributed to 39.6% of the observed variation statewide, the estimated contribution of maternal ethnicity ranged from 1.6-15.7% among Florida regions. CONCLUSIONS Hospital geographic location contributes to hospital variation in primary cesarean delivery rates among low-risk women in Florida. In contrast to previous studies, our findings suggest that individual level risk factors such as maternal ethnicity also contribute to some of this variation, with differing extent by region. These individual factors likely interact with practice factors and add to the variation. This study was limited by not including maternal Bishop score before induction or obstetrics provider in the analysis. These were not available on the dataset but likely contribute to the variation. Our findings suggest potential issues to consider in quality improvement efforts, such as the need for future qualitative research that focuses on mothers in higher-risk ethnic subgroups and providers in high-rate hospitals, particularly those in Miami-Dade County. These studies may help to identify potential cultural differences in maternal beliefs and expectations for delivery and maternal reasons for differences in obstetrics practices.
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Merry L, Vangen S, Small R. Caesarean births among migrant women in high-income countries. Best Pract Res Clin Obstet Gynaecol 2015; 32:88-99. [PMID: 26458998 DOI: 10.1016/j.bpobgyn.2015.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 08/13/2015] [Accepted: 09/06/2015] [Indexed: 01/05/2023]
Abstract
High caesarean birth rates among migrant women living in high-income countries are of concern. Women from sub-Saharan Africa and South Asia consistently show overall higher rates compared with non-migrant women, whereas women from Latin America and North Africa/Middle East consistently show higher rates of emergency caesarean. Higher rates are more common with emergency caesareans than with planned caesareans. Evidence regarding risk factors among migrant women for undergoing a caesarean birth is lacking. Research suggests that pathways leading to caesarean births in migrants are complex, and they are likely to involve a combination of factors related to migrant women's physical and psychological health, their social and cultural context and the quality of their maternity care. Migration factors, including length of time in receiving country and migration classification, have an influence on delivery outcome; however, their effects appear to differ by women's country/region of origin.
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Affiliation(s)
- Lisa Merry
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health, Department for Women and Children's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
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29
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Cheng ER, Declercq ER, Belanoff C, Iverson RE, McCloskey L. Racial and Ethnic Differences in the Likelihood of Vaginal Birth After Cesarean Delivery. Birth 2015; 42:249-53. [PMID: 26088760 PMCID: PMC4618667 DOI: 10.1111/birt.12174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND A major contributor to the increase in cesarean deliveries over recent decades is the decline in vaginal births after cesarean (VBAC). Racial and ethnic disparities in other perinatal outcomes are widely recognized, but few studies have been directed toward racial/ethnic differences in VBAC rates. METHODS We used the population-based Massachusetts Pregnancy to Early Life (PELL) database to investigate racial/ethnic differences in rates of VBAC for Massachusetts residents with one prior cesarean from 1998 to 2008. RESULTS The overall VBAC rate was 17.3 percent. After adjusting for demographic, behavioral, and medical risk factors, non-Hispanic Asian mothers had a greater likelihood of VBAC than non-Hispanic white mothers (adjusted risk ratio 1.31 [95% CI 1.23-1.39]). No other racial/ethnic group was significantly different from non-Hispanic whites in adjusted analyses. The likelihood of VBAC also decreased with increasing maternal age. DISCUSSION Non-Hispanic Asian women are significantly more likely to have VBAC than non-Hispanic white women. Efforts to reduce cesarean delivery rates in the United States should address these disparities. Future research should investigate factors underlying these differences to ensure that all women have access to appropriate maternity care services.
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Affiliation(s)
- Erika R. Cheng
- Post-doctoral Fellow, Harvard Medical School, Massachusetts General Hospital for Children, Division of General Academic Pediatrics, 100 Cambridge Street, 1570-B5, Boston, MA 02114, Tel: (617) 643-0473
| | - Eugene R. Declercq
- Professor, Community Health Sciences, Department of Community Health Sciences, Boston University School of Public Health, 810 Massachusetts Avenue, CT430, Boston, MA 02118
| | - Candice Belanoff
- Clinical Assistant Professor, Community Health Sciences, Department of Community Health Sciences, Boston University School of Public Health, 810 Massachusetts Avenue, CT429, Boston, MA 02118
| | - Ronald E. Iverson
- Director of Obstetrics and Assistant Professor of Obstetrics and Gynecology, Boston University School of Medicine, 10 Grove Street, East Boston, MA 02128
| | - Lois McCloskey
- Associate Professor, Community Health Sciences, Department of Community Health Sciences, Boston University School of Public Health, 810 Massachusetts Avenue, CT436, Boston, MA 02118
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Huesch M, Doctor JN. Factors associated with increased cesarean risk among African American women: evidence from California, 2010. Am J Public Health 2015; 105:956-62. [PMID: 25790391 DOI: 10.2105/ajph.2014.302381] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We studied if both observed and unobserved maternal health in African American women in hospitals or communities were associated with cesarean delivery of infants. METHODS We examined the relationship between African American race and cesarean delivery among 493 433 women discharged from 255 Californian hospitals in 2010 using administrative data; we adjusted for patient comorbidities and maternal, fetal, and placental risk factors, as well as clustering of patients within hospitals. RESULTS Cesarean rates were significantly higher overall for African American women than other women (unadjusted rate 36.8% vs 32.7%), as were both elective and emergency primary cesarean rates. Elevated risks persisted after risk adjustment (odds ratio generally > 1.27), but the prevalence of particular risk factors varied. Although African American women were clustered in some hospitals, the proportion of African Americans among all women delivering in a hospital was not related to its overall cesarean rate. CONCLUSIONS To address the higher likelihood of elective cesarean delivery, attention needs to be given to currently unmeasured patient-level health factors, to the quality of provider-physician interactions, as well as to patient preferences.
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Affiliation(s)
- Marco Huesch
- Marco Huesch is with the Sol Price School of Public Policy and the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California (USC), Los Angeles. At the time of the study, he was also with the Department of Community and Family Medicine, Duke University School of Medicine, and the Duke University Fuqua School of Business, Durham, NC. Jason N. Doctor is with the School of Pharmacy and the Leonard D. Schaeffer Center for Health Policy and Economics, USC
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31
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Edmonds JK, Hawkins SS, Cohen BB. The influence of detailed maternal ethnicity on cesarean delivery: findings from the U.S. birth certificate in the State of Massachusetts. Birth 2014; 41:290-8. [PMID: 24750358 PMCID: PMC4139447 DOI: 10.1111/birt.12108] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Our objective was to examine the likelihood of primary cesarean delivery for women at low risk for the procedure in Massachusetts. METHODS Birth certificate data for all births from 1996 to 2010 that were nulliparous, term, singleton, and vertex (NTSV; N = 427,393) were used to conduct logistic regression models to assess the likelihood of a cesarean delivery for each of the 31 ethnic groups relative to self-identified "American" mothers. The results were compared with broad classifications of race/ethnicity more commonly employed in research. RESULTS While 23.3 percent of American women had primary cesarean deliveries, cesarean delivery rates varied from 12.9 percent for Cambodian to 32.4 percent for Nigerian women. Women from 21 of 30 ethnic groups had higher odds of a primary cesarean (range of adjusted odds ratios [AORs] 1.09-1.77), while only Chinese, Cambodian, and Japanese women had lower odds (range of AORs 0.66-0.92), compared with self-identified "Americans." Using broad race/ethnicity categories, Non-Hispanic black, Hispanic, and "Other" women had higher odds of cesarean delivery relative to Non-Hispanic white women (range of AORs 1.12-1.47), while there were no differences for Asian or Pacific Islander women. CONCLUSIONS Detailed maternal ethnicity explains the variation in NTSV cesarean delivery rates better than broad race/ethnicity categories. Different patterns of cesarean delivery between ethnic groups suggest cultural specificity related to birth culture.
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Affiliation(s)
| | | | - Bruce B. Cohen
- Bureau of Health Information, Statistics, Research, and Evaluation, Massachusetts Department of Public Health, Boston, MA
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