BIRTH OPTIONS AFTER CESAREAN AMONG HISPANIC WOMEN LIVING IN THE UNITED STATES
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Date
2018-04-17
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Johns Hopkins University
Abstract
Objective: Hispanic women are more likely to have a repeat cesarean delivery(RCD) than non-Hispanic women. This study examined the relation between ethnicity/race and RCD, whether observed differences in RCD were due to differences in risk factors among women of different ethnicities/races and the perceptions about RCDs among Hispanic and non-Hispanic women with a previous cesarean delivery.
Methods: A retrospective cohort study was performed using 2010-2016 data from 1821 births to women with one previous cesarean birth at a District of Columbia hospital. Logistic regression was used to evaluate the relation between ethnicity and RCD and assess whether measureable risk factors for RCD account for differences by ethnicity. In-depth interviews were conducted in the third trimester and 1-3 days postpartum with 27 Hispanic and non-Hispanic women with one previous cesarean birth at the same facility from October 2016 to May 2017.
Results: The unadjusted odds of RCD were 26% lower for Hispanic women than for non-Hispanic white women; this finding was not statistically significant. Adjustment for demographic factors and anthropomorphic factors had little effect on the odds of RCD. Hispanic women, however, had statistically significant higher odds of RCD than non-Hispanic white women as did non-Hispanic black women when adjusting for obstetrical/medical factors. Qualitative findings suggested ethnic/racial differences in women’s trust of providers and in their perception of choice in birth options. Both Hispanic and non-Hispanic women stated preferences for vaginal birth after cesarean; no Hispanic women expressed a preference for RCD. Hispanic women reported less trust in their providers and less opportunity to formulate a delivery plan. All Hispanic women, even those in private practice, were delivered by providers whom they had not met.
Conclusions: Ethnic/racial differences in RCD odds were not accounted for by differences in demographic and anthropometric factors; in fact, statistical differences by ethnicity/race were not noted until adjustment was made for obstetrical and medical risk factors. RCD was not a preferred choice of delivery for women across ethnicity/race and Hispanic women reported distrust in provider recommendations. Interventions about choices of delivery options should consider socio-cultural perspectives to assist Hispanic women to be active participants in decision-making.
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Keywords
repeat cesarean, Hispanic, VBAC, vaginal birth after cesarean, RCD, repeat cesarean delivery, health disparities, ethnic disparities, racial disparities