Am J Perinatol 2023; 40(16): 1834-1840
DOI: 10.1055/s-0041-1739468
Original Article

Standardized Cesarean Risk Counseling with Induction: Impact on Racial Disparities in Birth Satisfaction

Rebecca F. Hamm
1   Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
2   Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
,
Sindhu K. Srinivas
1   Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
2   Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
,
1   Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Knashawn H. Morales
3   Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Lisa D. Levine
1   Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
› Institutsangaben
Funding This work was supported by The Penn Presbyterian George and Emily McMichael Harrison Fund for Research in ObGyn, a T32 Training Grant in Reproductive Epidemiology (identifier number: T32-HD007440), and a K23 Mentored Career Development Grant from the NICHD (identifier number: K23 HD102523).

Abstract

Objective Our prior work demonstrated decreased birth satisfaction for Black women undergoing labor induction. We aimed to determine if implementation of standardized counseling around calculated cesarean risk during labor induction could reduce racial disparities in birth satisfaction.

Study Design We implemented use of a validated calculator that provides an individual cesarean risk score for women undergoing induction into routine care. This prospective cohort study compared satisfaction surveys for 6 months prior to implementation (preperiod: January 2018–June 2018) to 1 year after (postperiod: July 2018–June 2019). Women with full-term (≥37 weeks) singleton gestations with intact membranes and an unfavorable cervix undergoing induction were included. In the postperiod, providers counseled patients on individual cesarean risk at the beginning of induction using standardized scripts. This information was incorporated into care at patient–provider discretion. The validated 10-question Birth Satisfaction Scale-Revised (BSS-R) subdivided into three domains was administered throughout the study. Patients were determined to be “satisfied” or “unsatisfied” if total BSS-R score was above or below the median, respectively. In multivariable analysis, interaction terms evaluated the differential impact of the calculator on birth satisfaction by race (Black vs. non-Black women).

Results A total of 1,008 of 1,236 (81.6%) eligible women completed the BSS-R (preperiod: 330 [79.7%] versus postperiod: 678 [82.5%], p = 0.23), 63.8% of whom self-identified as Black. In the preperiod, Black women were 50% less likely to be satisfied than non-Black women, even when controlling for differences in parity (Black: 39.0% satisfied vs. non-Black: 53.9%, adjusted odds ratio [aOR] = 0.49, 95% confidence interval [CI]: 0.30–0.79). In the postperiod, there was no difference in satisfaction by race (Black: 43.7% satisfied vs. non-Black: 44.0%, aOR = 0.97. 95% CI: 0.71–1.33). Therefore, disparities in birth satisfaction were no longer present at postimplementation (interaction p = 0.03).

Conclusion Implementation of standardized counseling with a validated calculator to predict cesarean risk after labor induction is associated with a decrease in racial disparities in birth satisfaction.

Key Points

  • Preintervention, Black women were less likely to have above-median birth satisfaction.

  • We implemented standardized counseling around cesarean risk with labor induction.

  • Implementation was associated with reduced racial disparities in birth satisfaction scores.

Supplementary Material



Publikationsverlauf

Eingereicht: 25. Mai 2021

Angenommen: 03. Oktober 2021

Artikel online veröffentlicht:
16. November 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Sadler LC, Davison T, McCowan LM. Maternal satisfaction with active management of labor: a randomized controlled trial. Birth 2001; 28 (04) 225-235
  • 2 Goodman P, Mackey MC, Tavakoli AS. Factors related to childbirth satisfaction. J Adv Nurs 2004; 46 (02) 212-219
  • 3 Shetty A, Burt R, Rice P, Templeton A. Women's perceptions, expectations and satisfaction with induced labour–a questionnaire-based study. Eur J Obstet Gynecol Reprod Biol 2005; 123 (01) 56-61
  • 4 Henderson J, Redshaw M. Women's experience of induction of labor: a mixed methods study. Acta Obstet Gynecol Scand 2013; 92 (10) 1159-1167
  • 5 Creanga AA, Bateman BT, Kuklina EV, Callaghan WM. Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010. Am J Obstet Gynecol 2014; 210 (05) 435.e1-435.e8
  • 6 Hirshberg A, Srinivas SK. Epidemiology of maternal morbidity and mortality. Semin Perinatol 2017; 41 (06) 332-337
  • 7 Hamm RF, Srinivas SK, Levine LD. Risk factors and racial disparities related to low maternal birth satisfaction with labor induction: a prospective, cohort study. BMC Pregnancy Childbirth 2019; 19 (01) 530
  • 8 Howell EA, Zeitlin J. Quality of care and disparities in obstetrics. Obstet Gynecol Clin North Am 2017; 44 (01) 13-25
  • 9 Sheeran P, Gollwitzer PM, Bargh JA. Nonconscious processes and health. Health Psychol 2013; 32 (05) 460-473
  • 10 Santry HP, Wren SM. The role of unconscious bias in surgical safety and outcomes. Surg Clin North Am 2012; 92 (01) 137-151
  • 11 FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017; 18 (01) 19
  • 12 Levine LD, Downes KL, Parry S, Elovitz MA, Sammel MD, Srinivas SK. A validated calculator to estimate risk of cesarean after an induction of labor with an unfavorable cervix. Am J Obstet Gynecol 2018; 218 (02) 254.e1-254.e7
  • 13 Hamm RF, Downes KL, Srinivas SK, Levine LD. Using the probability of cesarean from a validated cesarean prediction calculator to predict labor length and morbidity. Am J Perinatol 2019; 36 (06) 561-566
  • 14 Hollins Martin CJ, Martin CR. Development and psychometric properties of the birth satisfaction scale-revised (BSS-R). Midwifery 2014; 30 (06) 610-619
  • 15 Martin CR, Hollins Martin CJ, Burduli E, Barbosa-Leiker C, Donovan-Batson C, Fleming SE. Measurement and structural invariance of the US version of the birth satisfaction scale-revised (BSS-R) in a large sample. Women Birth 2017; 30 (04) e172-e178
  • 16 Fleming SE, Donovan-Batson C, Burduli E, Barbosa-Leiker C, Hollins Martin CJ, Martin CR. Birth satisfaction scale/birth satisfaction scale-revised (BSS/BSS-R): A large scale United States planned home birth and birth centre survey. Midwifery 2016; 41: 9-15
  • 17 Hamm RF, Levine LD, Nelson MN, Beidas R. Implementation of a calculator to predict cesarean during labor induction: a qualitative evaluation of the clinician perspective. Am J Obstet Gynecol MFM 2021; 3 (03) 100321
  • 18 Akca A, Corbacioglu Esmer A, Ozyurek ES. et al. The influence of the systematic birth preparation program on childbirth satisfaction. Arch Gynecol Obstet 2017; 295 (05) 1127-1133
  • 19 Mirghafourvand M, Mohammad Alizadeh Charandabi S, Ghanbari-Homayi S, Jahangiry L, Nahaee J, Hadian T. Effect of birth plans on childbirth experience: A systematic review. Int J Nurs Pract 2019; 25 (04) e12722
  • 20 Idossa D, Duma N, Chekhovskiy K, Go R, Ailawadhi S. Commentary: race and ethnicity in biomedical research - classifications, challenges, and future directions. Ethn Dis 2018; 28 (04) 561-564
  • 21 Corbie-Smith G, Henderson G, Blumenthal C, Dorrance J, Estroff S. Conceptualizing race in research. J Natl Med Assoc 2008; 100 (10) 1235-1243