Patient‐Perceived Pressure from Clinicians for Labor Induction and Cesarean Delivery: A Population‐Based Survey of U.S. Women. (23rd September 2014)

• Record Type: Journal Article
• Authors: Jou, Judy; Kozhimannil, Katy B.; Johnson, Pamela Jo; Sakala, Carol
• Is Part Of: Health services research. Volume 50:Number 4(2015)
• Page Start: 961
• Page End: 981
• Publication Date: 2014-09-23
• Subjects: Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12231
• Languages: English
• ISSNs: 0017-9124

Abstract

<abstract abstract-type="main" id="hesr12231-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hesr12231-sec-0001" sec-type="section"> <title>Objective</title> <p>To determine whether patient‐perceived pressure from clinicians for labor induction or cesarean delivery is significantly associated with having these procedures.</p> </sec> <sec id="hesr12231-sec-0002" sec-type="section"> <title>Data Sources/Study Setting</title> <p> <italic>Listening to Mothers III</italic>, a nationally representative survey of women 18–45 years who delivered a singleton infant in a U.S. hospital July 2011–June 2012 (<italic>N</italic> = 2, 400).</p> </sec> <sec id="hesr12231-sec-0003" sec-type="section"> <title>Study Design</title> <p>Multivariate logistic regression analysis of factors associated with perceived pressure and estimation of odds of induction and cesarean given perceived pressure.</p> </sec> <sec id="hesr12231-sec-0004" sec-type="section"> <title>Principal Findings</title> <p>Overall, 14.8 percent of respondents perceived pressure from a clinician for labor induction and 13.3 percent for cesarean delivery. Women who perceived pressure for labor induction had higher odds of induction overall (adjusted odds ratio [aOR]: 3.51; 95 percent confidence interval [CI]: 2.5–5.0) and without medical reason (aOR: 2.13; 95 percent CI: 1.3–3.4) compared with women who did not perceive pressure. Those perceiving pressure for cesarean delivery had higher odds of cesarean overall (aOR: 5.17; 95 percent CI: 3.2–8.4), without medical reason (aOR: 6.13; 95 percent CI: 3.4–11.1), and unplanned cesarean (aOR: 6.70; 95 percent CI: 4.0–11.3).</p> </sec> <sec id="hesr12231-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Patient‐perceived pressure from clinicians significantly predicts labor induction and cesarean delivery. Efforts to reduce provider–patient miscommunication and minimize potentially unnecessary procedures may be warranted.</p> </sec> </abstract>