Employment During Pregnancy and Obstetric Intervention Without Medical Reason: Labor Induction and Cesarean Delivery



      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.


      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.


      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.


      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.
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      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.


      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.


      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.


      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.


      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.