Abstract
Background
Rising rates of labor induction and cesarean delivery, especially when used without
a medical reason, have generated concern among clinicians, women, and policymakers.
Whether employment status affects pregnant women's childbirth-related care is not
known. We estimated the relationship between prenatal employment and obstetric procedures,
distinguishing whether women reported that the induction or cesarean was performed
for medical reasons.
Methods
Using data from a nationally representative sample of women who gave birth in U.S.
hospitals (n = 1,573), we used propensity score matching to reduce potential bias from nonrandom
selection into employment. Outcomes were cesarean delivery and labor induction, with
and without a self-reported medical reason. Exposure was prenatal employment status
(full-time employment, not employed). We conducted separate analyses for unmatched
and matched cohorts using multivariable regression models.
Findings
There were no differences in labor induction based on employment status. In unmatched
analyses, employed women had higher odds of cesarean delivery overall (adjusted odds
ratio [AOR], 1.45; p = .046) and cesarean delivery without medical reason (AOR, 1.94; p = .024). Adding an interaction term between employment and college education revealed
no effects on cesarean delivery without medical reason. There were no differences
in cesarean delivery by employment status in the propensity score–matched analysis.
Conclusions
Full-time prenatal employment is associated with higher odds of cesarean delivery,
but this association was not explained by socioeconomic status and no longer existed
after accounting for sociodemographic differences by matching women employed full
time with similar women not employed during pregnancy.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Women's Health IssuesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Riley L.E. Stark A.R. Guidelines for perinatal care (AAP/ACOG). 7th ed. American Academy of Pediatrics, Washington, DC2012
- ACOG practice bulletin no. 107: Induction of labor.Obstetrics & Gynecology. 2009; 114: 386-397
- ACOG committee opinion No. 394, December 2007. Cesarean delivery on maternal request.Obstetrics & Gynecology. 2007; 110: 1501
- Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1.Obstetrics & Gynecology. 2014; 123: 693-711
- A Review of hot deck imputation for survey non-response.International Statistical Review. 2010; 78: 40-64
- Blueprint for action: Steps toward a high-quality, high-value maternity care system.Women’s Health Issues. 2010; 20: S18-S49
- Safety in numbers: The development of Leapfrog’s composite patient safety score for U.S. Hospitals.Journal of Patient Safety. 2014; 10 (Available at:): 64-71
- A critical appraisal of propensity score matching in the medical literature between 1996 and 2003.Statistics in Medicine. 2008; 27: 2037-2049
- Changes in the indications for scheduled births to reduce nonmedically indicated deliveries occurring before 39 weeks of gestation.Obstetrics & Gynecology. 2012; 120: 241-245
- Maternal employment, breastfeeding, and health: Evidence from maternity leave mandates.Journal of Health Economics. 2008; 27: 871-887
- Indications contributing to the increasing cesarean delivery rate.Obstetrics & Gynecology. 2011; 118: 29-38
- Maternal work and birth outcome disparities.Maternal Child Health Journal. 2008; 12: 415-426
- Maternity leave, early maternal employment and child health and development in the US.Economic Journal. 2005; 115: F29-F47
- Toward improving the outcome of pregnancy III: Enhancing perinatal health through quality, safety and performance initiatives.March of Dimes National Foundation, White Plains, NY2010
- Dual problem of costs. Health systems face continuing challenges as both purchasers and providers.Modern Healthcare. 2012; 42: 30-31
- Maternal stress exposures, reactions, and priorities for stress reduction among low-income, urban women.Journal of Midwifery & Women’s Health. 2012; 58: 167-174
- Socioeconomic disparities in adverse birth outcomes: A systematic review.American Journal of Preventive Medicine. 2010; 39: 263-272
- Socioeconomic disparities in health in the United States: What the patterns tell us.American Journal of Public Health. 2010; 100: S186-S196
Catalyst for Payment Reform. (n.d.). Maternity care payment. Action brief. Catalyst for Payment Reform. Available at: http://catalyzepaymentreform.org/images/documents/maternity. Accessed January 18, 2014.
- Evidence-based strategies for reducing cesarean section rates: A meta-analysis.Birth. 2007; 34: 53-64
- Family leave after childbirth and the mental health of new mothers.Journal of Mental Health Policy and Economics. 2012; 15: 61-76
- Effects of early maternal employment on maternal health and well-being.Journal of Population Economics. 2013; 26: 285-301
- Scheduled deliveries: Avoiding iatrogenic prematurity.American Journal of Perinatology. 2012; 29: 27-33
Childbirth Connection. (n.d.). Listening to mothers surveys and reports. Available at: www.childbirthconnection.org/listeningtomothers/. Accessed February 20, 2013.
- Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.Statistics in Medicine. 1998; 2281: 2265-2281
- Maternal risk profiles and the primary cesarean rate in the United States, 1991-2002.American Journal of Public Health. 2006; 96: 867-872
- Listening to mothers II: Report of the second National Survey of Women’s Childbearing Experiences.Childbirth Connection, New York2006
- Listening to Mothers III: Pregnancy and Childbirth.Childbirth Connection, New York2013
- Cesarean delivery and the risk-benefit calculus.New England Journal of Medicine. 2007; 356: 885-888
- Clinical practice guidelines we can trust.National Academies Press, Washington, D.C2011
- Maternity leave in the ninth month of pregnancy and birth outcomes among working women.Women’s Health Issues. 2009; 19: 30-37
- Estimation of causal effects using propensity score weighting: An application to data on right heart catheterization.Health Services and Outcomes Research Methodology. 2001; 2: 259-278
- Prepartum work, job characteristics, and risk of cesarean delivery.Birth. 2002; 29: 10-17
- Neighborhood poverty and American Indian infant death: Are the effects identifiable?.Annals of Epidemiology. 2008; 18: 552-559
- Maternity leave and employment patterns of first-time mothers: 1961-2008.(Current population report, P70-113) U.S. Census Bureau, Washington, DC2008
- Re-evaluating the relationship between prenatal work and birth outcomes.Women's Health Issues. 2013; 23: e77-e85
- Creating a public agenda for maternity safety and quality in cesarean delivery.Obstetrics & Gynecology. 2012; 120: 1194-1198
- Hotdeck imputation.Stata Technical Bulletin. 1999; 51: 32-34
- Births: Final data for 2010.National Vital Statistics Reports. 2012; 61: 1990-2010
- Indications for induction of labour: A best-evidence review.BJOG: An International Journal of Obstetrics & Gynaecology. 2009; 116: 626-636
- Effects of psychosocial characteristics of work on pregnancy outcomes: a critical review.Women & Health. 2011; 51: 279-297
- Propensity score matching for social epidemiology.in: Oakes J.M. Kaufman J.S. Methods in social epidemiology. Jossey-Bass, San Francisco2006: 370-392
- How to stop the relentless rise in cesarean.Obstetrics & Gynecology. 2011; 118: 199-200
- Data analysis using hot deck multiple imputation.Statistician. 1993; : 307-313
- Estimating causal effects from large data sets using propensity scores.Annals of Internal Medicine. 1997; 127: 757-763
- Policies to assist parents with young children.Future Child. 2011; 21: 37-68
- Carol Sakala’s letter from North America: An uncontrolled experiment: Elective delivery predominates in the United States.Birth. 2006; 33: 332-335
- Vaginal birth after cesarean delivery: A common-sense approach.Obstetrics and Gynecology. 2011; 118: 342-350
- Preventing the first cesarean delivery.Obstetrics & Gynecology. 2012; 120: 1181-1193
- Decision aids for people facing health treatment or screening decisions (review).Cochrane Database of Systematic Reviews. 2011;
- Improving return-to-work after childbirth: Design of the [email protected] study, a randomised controlled trial and cohort study.BMC Public Health. 2007; 7: 43
- Touchdown! Online polling scores big in November 2000.Public Perspective. 2001; 12: 38-39
- Correcting data from online surveys for the effects of nonrandom selection and nonrandom assignment.Harris Interactive White Paper. 2000; : 1-13
The Joint Commission. (2012). Measure set: Perinatal care (PC); Set measure ID: PC-02. Specifications manual for Joint Commission National Quality Measures (v2013A1). Available at: https://manual.jointcommission.org/releases/TJC2013A/MIF0167.html. Accessed February 20, 2013.
- 2020 vision for a high-quality, high-value maternity care system.Women’s Health Issues. 2010; 20: S7-17
- Medically indicated iatrogenic prematurity.Clinics in Perinatology. 2011; 38: 423-439
- Scientific evidence underlying the American College of Obstetricians and Gynecologists’ practice bulletins.Obstetrics & Gynecology. 2011; 118: 505-512
- The downside of cesarean delivery: Short- and long-term complications.Clinical Obstetrics and Gynecology. 2004; 47: 386-393
Biography
Katy Backes Kozhimannil, PhD, MPA, is Assistant Professor in the Division of Health Policy and Management at the University of Minnesota. She is a health policy analyst who studies institutional and government policies affecting health care delivery, quality, and outcomes for women and families.
Biography
Laura B. Attanasio, BA, is a doctoral student in the Division of Health Policy and Management, University of Minnesota. She applies sociological and health services research methods to questions of equity in maternal and reproductive health care.
Biography
Pamela Jo Johnson, PhD, MPH, is a Research Investigator and Medica Research Institute. She is a health services epidemiologist with broad interests in population health focusing on social disparities in health and health care.
Biography
Dwenda K. Gjerdingen, MD, MS, is a family physician and Professor at the University of Minnesota Medical School. She maintains an active clinical practice while also conducting research on women's mental and physical health, with a focus on pregnancy and the postpartum period.
Biography
Patricia M. McGovern, PhD, MPH, is Professor in the Division of Environmental Health Sciences at the University of Minnesota. Her research applies the tools of health services research and policy to occupational and environmental health issues, in particular, issues of women's and children's health.
Article info
Publication history
Accepted:
June 23,
2014
Received in revised form:
April 5,
2014
Received:
November 24,
2013
Footnotes
Disclosure statement: The authors have no conflicts of interest.
Identification
Copyright
© 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
