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

Rebecca F. Hamm; Sindhu K. Srinivas; Jennifer Mccoy; Knashawn H. Morales; Lisa D. Levine

doi:10.1055/s-0041-1739468

American Journal of Perinatology, Table of Contents

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

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

²Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania

,

Sindhu K. Srinivas

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

²Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania

,

Jennifer Mccoy

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

,

Knashawn H. Morales

³Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

,

Lisa D. Levine

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

› Author Affiliations

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.

Keywords

birth satisfaction - BSS-R - cesarean delivery - cesarean risk - counseling - disparities - implementation - labor induction - satisfaction - standardization

Full Text

References

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Supplementary Material

Supplementary Material