Research Activities, May 2013
Women less likely to undergo cesarean deliveries if their doctors listen and respond to their concerns
The rate of cesarean delivery in the United States steadily grew from 20.7 percent in 1996 to 32.9 percent in 2009, a record high. Experts recommend that this rate be reduced. Women who reported that their prenatal care providers listened and responded to their concerns were less likely to undergo cesarean delivery, reveals a new study. However, women who felt empowered and had confidence in their self-care were more likely to deliver by cesarean.
The study included 1,308 women who had just given birth at 2 hospitals: a suburban health maintenance organization medical center and an urban public hospital. Bilingual and bicultural interviewers (English and Spanish) asked the women questions to elicit information on interpersonal processes of care (IPC), such as communication issues, patient-centered decisionmaking, and the interpersonal style of the provider. Researchers also reviewed the women’s medical records. Rates of cesarean delivery were 22.6 percent at the public hospital and 30.1 percent at the medical center.
Women who scored higher on the IPC item related to the physician’s elicitation of patient problems and responsiveness were 84 percent less likely to undergo a cesarean. However, women who had higher scores on the IPC item on empowerment and self-care were twice as likely to deliver by cesarean. The researchers also found that women with poor or no English proficiency were 96 percent less likely to have a cesarean compared to women with higher proficiency. Women younger than 22 years old were half as likely to deliver by cesarean compared to women ages 22 to 35. The study findings suggest that clinicians need to emphasize and improve their communication with patients during prenatal care to reduce unnecessary cesarean sections. The study was supported by AHRQ (HS10856).
"Interpersonal processes of care and Cesarean delivery in two health care settings," by Nancy A. Hessol, M.S.P.H., Roxana Odouli, M.P.H., Gabriel J. Escobar, M.D., Elena Fuentes-Afflick, M.D., M.P.H., and others in the September 2012 American Journal of Public Health 102(9), pp. 1722-1728.