Social disparities in delivery choice among patients with history of cesarean.

Autor: Wetzler SR; Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai Hospital, USA. Electronic address: Sara.wetzler@icahn.mssm.edu., Tavella NF; Division of Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai Hospital, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, USA., McCarthy L; Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai Hospital, USA., Baptiste G; Division of Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai Hospital, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, USA., Stern T; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, USA., DeBolt C; Division of Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai Hospital, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, USA., Bianco A; Division of Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai Hospital, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, USA.
Jazyk: angličtina
Zdroj: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives [Sex Reprod Healthc] 2024 Sep; Vol. 41, pp. 101011. Date of Electronic Publication: 2024 Jul 31.
DOI: 10.1016/j.srhc.2024.101011
Abstrakt: Objective: Given the call to reduce rates of non-medically indicated cesarean deliveries (CDs) by encouraging trials of labor after cesarean (TOLAC), this study looks at social characteristics of patients choosing a TOLAC versus a scheduled repeat cesarean delivery (SRCD) to determine disparities regarding delivery method choice.
Methods: This was a retrospective cohort study of patients with a history of one CD between April 29, 2015-April 29, 2020. Patients were divided based on type of delivery chosen at admission. Chi-squared tests examined proportional differences between groups and logistic regression models examined odd ratios of choosing TOLAC versus SRCD according to socially dependent categories including race/ethnicity, health insurance, pre-pregnancy body mass index, and Social Vulnerability Index (SVI).
Results: 1,983 patients were included. Multivariable logistic regression models revealed that patients with a high SVI (reference: low/medium SVI) (AOR 2.0, CI: 1.5, 2.5), self-identified as Black/ African American (AOR: 2.4, CI: 1.6, 3.6) or Hispanic/Latina (AOR: 2.0, CI: 1.4, 2.8) (reference: White), had public insurance (reference: private insurance) (AOR: 3.7, CI: 2.8, 5.0), and who had an obese BMI (reference: non-obese BMI) were more likely to opt for a TOLAC rather than SRCD.
Conclusion: These findings demonstrate differences in delivery method preferences. Specifically, more disadvantaged patients are more likely to choose TOLAC, suggesting that social and economic factors may play a role in delivery preferences. These findings have implications for improving individualized counselling and engaging in shared decision-making around mode of delivery.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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