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

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 non-random 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=0.046) and cesarean delivery without medical reason (AOR=1.94, p=0.024). Adding an interaction term between employment and college education revealed no significant effects on cesarean without medical reason. There were no significant 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 socio-economic status and no longer existed after accounting for socio-demographic differences by matching women employed full-time with similar women not employed during pregnancy.

Factors associated with caesarean sections among mothers delivering at Mama Lucy Kibaki Hospital, Nairobi, Kenya between January and March, 2015: a case-control study

“…Being employed was associated with a mother delivering through CS among women in Nairobi, Kenya. Studies in the United States and Brazil also found that employed women who were employed prenatally were more likely to deliver through CS compared to unemployed women [ 11 , 12 ]. We also found that mothers who underwent CS were at lower odds of having babies with normal birth weights because many of the low birth weight babies are premature and like babies with Cephalo pelvic disproportion are delivered through CS [ 13 , 14 ].…”

Midwife‐led care and obstetrician‐led care for low‐risk pregnancies: A cost comparison

“…Women were coded as having had a labor induction if they reported that a health care practioner had used a medical method to try to cause their labor to begin. We classified inductions as having occurred for a definitive medical reason or not for a definitive medical reason based on women's reported reasons for the induction, consistent with previously published studies (see Appendix S1 for full categorization) . Gestational lengths less than 37 completed weeks were categorized as preterm.…”