Time trends in births and cesarean deliveries among women with disabilities

Abstract

Background Although it is likely that childbearing among women with disabilities is increasing, no empirical data have been published on changes over time in the numbers of women with disabilities giving birth. Further, while it is known that women with disabilities are at increased risk of cesarean delivery, temporal trends in cesarean deliveries among women with disabilities have not been examined. Objective To assess time trends in births by any mode and in primary cesarean deliveries among women with physical, sensory, or intellectual/developmental disabilities. Methods We conducted a retrospective cohort study using linked vital records and hospital discharge data from all deliveries in California, 2000–2010 (n=4,605,061). We identified women with potential disabilities using ICD-9 codes. We used descriptive statistics and visualizations to examine time patterns. Logistic regression analyses assessed the association between disability and primary cesarean delivery, stratified by year. Results Among all women giving birth, the proportion with a disability increased from 0.27% in 2000 to 0.80% in 2010. Women with disabilities had significantly elevated odds of primary cesarean delivery in each year, but the magnitude of the odds ratio decreased over time from 2.60 (95% CI=2.25=2.99) in 2000 to 1.66 (95% CI=1.51–1.81) in 2010. Conclusions Adequate clinician training is needed to address the perinatal care needs of the increasing numbers of women with disabilities giving birth. Continued efforts to understand cesarean delivery patterns and reasons for cesarean deliveries may help guide further reductions in proportions of cesarean deliveries among women with disabilities relative to women without disabilities.

Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis

“…Twenty-three studies, representing 8,514,356 women in 19 distinct cohorts (including 1 US study that examined 4 states separately), 50 met our inclusion criteria and were included in the qualitative synthesis. Three articles from Canada [44][45][46] and 9 from the United States representing 3 different investigations (2 using California administrative data, 49,53 5 using the Pregnancy to Early Life Longitudinal Data System, 47,48,56,58,59 and 2 using the Pregnancy Risk Assessment Monitoring System for Rhode Island 57,61 ) used the same data sources and had fully or partially overlapping samples and study periods. Table 3 describes the studies' characteristics.…”

Miscarriage Occurrence and Prevention Efforts by Disability Status and Type in the United States

“…1,2 Research to date has demonstrated disparities for women with disabilities in prenatal care utilization and satisfaction with prenatal care, preterm birth, having infants small for gestational age, and high rates of cesarean deliveries. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The majority of this research is based on delivery records or surveys like the Pregnancy Risk Assessment Monitoring System (PRAMS), which contain only live birth outcomes and therefore do not reflect early pregnancy loss or miscarriage. Thus, considerably less is known about the association between disability and miscarriage.…”

Maternal Health Care Seeking Behavior of Peri-Urban Women With Disability in Busiro South, Wakiso District, Uganda: a Community Based Study

“…The proportion of women with disabilities who give birth is on the rise despite the little attention given to them [6]. According to the global disability report of 2011, women with disability in reproductive age faced different challenges including: denying them care at health facilities (21%); lack of knowledge on where to go for a service (11.8%); and mistreatment by health workers (15.5%) [7]. In addition, the report highlighted that the health workers did not have enough skills to attend to women with disability, and affordability costs further complicate their health seeking behavior.…”

“…In addition, the report highlighted that the health workers did not have enough skills to attend to women with disability, and affordability costs further complicate their health seeking behavior. Relatedly, other studies have raised numerous challenges including limited affordability to visit health facilities that was reported among 58.7% of women with disability in reproductive age, 16% had no transport means to the health facility, and 25.8% could not afford the prohibitive costs of transport [7]. These factors are main barrier to accessing sexual and reproductive health services, and may portend global efforts to achieve SDG-5 [7].…”

“…Relatedly, other studies have raised numerous challenges including limited affordability to visit health facilities that was reported among 58.7% of women with disability in reproductive age, 16% had no transport means to the health facility, and 25.8% could not afford the prohibitive costs of transport [7]. These factors are main barrier to accessing sexual and reproductive health services, and may portend global efforts to achieve SDG-5 [7]. Further, the need for some persons with disabilities to have someone accompany them on the health visit not only increases transportation costs, but also raises issues of con dentiality [8,9].…”