Rate of Primary Cesarean Delivery by Language Preference among Nulliparas

Abstract

Objective: Sociodemographic factors such as race/ethnicity and socioeconomic status affect primary cesarean delivery rates. Language is associated with disparate healthcare outcomes, but has not been well studied in obstetrics. We examined the association between primary unscheduled cesarean delivery rate and preferred patient language. Study Design: A retrospective cohort study was conducted at an urban medical center between 1/2017 and 1/2020. Nulliparous women with early or full term gestation without obstetric or medical contraindication to vaginal delivery were included. We used multivariable linear and logistic regressions to evaluate language differences in cesarean delivery odds and indication for cesarean. Results: Of the 1314 eligible women, 76.3% of patients preferred English, 17.8% Spanish and 5.4% other languages. Overall cesarean delivery rate was 27.6%. Controlling for age, race/ethnicity, BMI, insurance, gravidity, pregnancy comorbidities, labor induction, and infant birthweight, Spanish and other-language speaking women had significantly higher odds of undergoing cesarean compared to English-speaking women (adjusted odds ratio: 1.75; 95% CI: 1.25, 2.46). Relative proportions of indications for cesarean did not differ by language group. Documented interpreter use was an effect modifier on the relationship between language preference and cesarean (odds ratio with interpreter use: 2.89, CI 1.90, 4.39). Conclusions: Primary cesarean delivery rates were significantly higher among nulliparous women who prefer languages other than English. This difference may reflect lack of communication, provider bias or discrimination, or other factors, and should be further studied. Interpreter services should be routinely utilized and documented effectively.

Análise da incidência e indicações de cesáreas na Maternidade Escola de Valença/RJ

“…A decisão entre parto vaginal e cesáreo tem sido objeto de intenso debate na comunidade obstétrica, com um consenso emergente de que a preferência por cesáreas pode estar crescendo, apesar das recomendações para limitar cesáreas a indicações médicas claras (Elgzar, 2023;Brown, 2023;Comfort, 2023). A escolha obstétrica da via de parto impacta diretamente a frequência de partos vaginais futuros.…”

“…Além disso, o estudo visa compreender os motivos por trás das altas taxas de cesariana no Brasil, considerando aspectos como preferências pessoais, condições clínicas e práticas médicas (Pires et al, 2023;Angolile et al, 2023). A análise das tendências e práticas obstétricas em hospitais é vital para informar futuras políticas e intervenções de saúde (Comfort et al, 2023;Elgzar et al, 2023).…”