Standardized Cesarean Risk Counseling with Induction: Impact on Racial Disparities in Birth Satisfaction

2021 ◽  
Author(s):  
Rebecca F. Hamm ◽  
Sindhu K. Srinivas ◽  
Jennifer Mccoy ◽  
Knashawn H. Morales ◽  
Lisa D. Levine
Keyword(s):  
Black Women ◽  
Racial Disparities ◽  
Multivariable Analysis ◽  
Routine Care ◽  
Labor Induction ◽  
Satisfaction Scale ◽  
Interaction Terms ◽  
Birth Satisfaction ◽  
Key Points ◽  
Unfavorable Cervix

Objective Our prior work demonstrated decreased birth satisfaction for Black women undergoing labor induction. We aimed to determine if implementation of standardized counseling around calculated cesarean risk during labor induction could reduce racial disparities in birth satisfaction. Study Design We implemented use of a validated calculator that provides an individual cesarean risk score for women undergoing induction into routine care. This prospective cohort study compared satisfaction surveys for 6 months prior to implementation (preperiod: January 2018–June 2018) to 1 year after (postperiod: July 2018–June 2019). Women with full-term (≥37 weeks) singleton gestations with intact membranes and an unfavorable cervix undergoing induction were included. In the postperiod, providers counseled patients on individual cesarean risk at the beginning of induction using standardized scripts. This information was incorporated into care at patient–provider discretion. The validated 10-question Birth Satisfaction Scale-Revised (BSS-R) subdivided into three domains was administered throughout the study. Patients were determined to be “satisfied” or “unsatisfied” if total BSS-R score was above or below the median, respectively. In multivariable analysis, interaction terms evaluated the differential impact of the calculator on birth satisfaction by race (Black vs. non-Black women). Results A total of 1,008 of 1,236 (81.6%) eligible women completed the BSS-R (preperiod: 330 [79.7%] versus postperiod: 678 [82.5%], p = 0.23), 63.8% of whom self-identified as Black. In the pre-period, Black women were 50% less likely to be satisfied than non-Black women, even when controlling for differences in parity (Black: 39.0% satisfied vs. non-Black: 53.9%, adjusted odds ratio [aOR] = 0.49, 95% confidence interval [CI]: 0.30–0.79). In the postperiod, there was no difference in satisfaction by race (Black: 43.7% satisfied vs. non-Black: 44.0%, aOR = 0.97. 95% CI: 0.71–1.33). Therefore, disparities in birth satisfaction were no longer present at postimplementation (interaction p = 0.03). Conclusion Implementation of standardized counseling with a validated calculator to predict cesarean risk after labor induction is associated with a decrease in racial disparities in birth satisfaction. Key Points

scholarly journals Risk factors and racial disparities related to low birth satisfaction with labor induction: a prospective, cohort study

2019 ◽  
Author(s):  
Rebecca F Hamm ◽  
Sindhu K Srini ◽  
Lisa D Levine
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Black Women ◽  
Racial Disparities ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Labor Induction ◽  
Cesarean Birth ◽  
Birth Satisfaction ◽  
Labor Length

Abstract Background: Decreased birth satisfaction has been associated with labor induction. Yet, there is a paucity of data evaluating risk factors for decreased satisfaction associated with labor induction. We aimed to determine what factors impact low birth satisfaction in labor induction and evaluate racial disparities in birth satisfaction.Methods: We performed a prospective cohort study of women with term, singleton gestations undergoing labor induction at our institution from 1/2018-6/2018. Women completed the validated Birth Satisfaction Scale-Revised postpartum, which is subdivided into 3 domains. A total satisfaction score above the mean was classified as “satisfied”, and below as “unsatisfied.” Domain and item scores were compared by race. Results: 330 of 414 (79.7%) eligible women were included. There was no significant difference in birth satisfaction by age, body mass index, Bishop score, or induction agent. Black women were more 75% likely to be unsatisfied than non-Black women (54.0% vs. 37.2%, OR 1.75 [95%CI 1.11-2.76], p=0.037), nulliparas were more 71% likely to be unsatisfied than multiparas (54.2% vs. 40.9%, OR 1.71 [95%CI 1.09-2.67], p=0.019), and women whose labor resulted in cesarean birth were more almost 3 times more likely to be unsatisfied than women with a vaginal birth (67.4% vs. 42.3%, OR 2.82 [95%CI 1.69-4.70], p<0.001). Additionally, increased labor length quartile was associated with decreased satisfaction (p=0.003). By race, domain 3 scores, which reflect preparedness for labor, were lower for Black women. No differences were seen for domain 1 or 2.Conclusions: Black race, cesarean birth, and increasing labor length were identified as risk factors for low birth satisfaction among induced women. Further studies should explore interventions to target women at risk for low birth satisfaction.

scholarly journals Risk factors and racial disparities related to low maternal birth satisfaction with labor induction: a prospective, cohort study

2019 ◽  
Author(s):  
Rebecca F Hamm ◽  
Sindhu K Srini ◽  
Lisa D Levine
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Black Women ◽  
Racial Disparities ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Labor Induction ◽  
Cesarean Birth ◽  
Birth Satisfaction ◽  
Labor Length

Abstract Background: Decreased birth satisfaction has been associated with labor induction. Yet, there is a paucity of data evaluating risk factors for decreased satisfaction associated with labor induction. We aimed to determine what factors impact low birth satisfaction in labor induction and evaluate racial disparities in birth satisfaction. Methods: We performed a prospective cohort study of women with term, singleton gestations undergoing labor induction at our institution from Jan 2018 to Jun 2018. Women completed the validated Birth Satisfaction Scale-Revised postpartum, which is subdivided into 3 domains: (1) quality of care provision, (2) women's personal attributes, and (3) stress experienced during labor. A total satisfaction score above the mean was classified as “satisfied”, and below as “unsatisfied.” Domain and item scores were compared by race. Results: 330 of 414 (79.7%) eligible women were included. There was no significant difference in birth satisfaction by age, body mass index, Bishop score, or labor induction agent. Black women were more 75% likely to be unsatisfied than non-Black women (54.0% vs. 37.2%, OR 1.75 [95%CI 1.11-2.76], p=0.037), nulliparas were more 71% likely to be unsatisfied than multiparas (54.2% vs. 40.9%, OR 1.71 [95%CI 1.09-2.67], p=0.019), and women whose labor resulted in cesarean birth were more almost 3 times more likely to be unsatisfied than women with a vaginal birth (67.4% vs. 42.3%, OR 2.82 [95%CI 1.69-4.70], p<0.001). Additionally, increased labor length quartile was associated with decreased satisfaction (p=0.003). By race, domain 3 scores, which reflect preparedness for labor, were lower for Black women. No differences were seen for domain 1 or 2. Conclusions: Black race, cesarean birth, and increasing labor length were identified as risk factors for low birth satisfaction among women who underwent labor induction. Further studies should explore interventions to target women at risk for low birth satisfaction.

scholarly journals Risk factors and racial disparities related to low maternal birth satisfaction with labor induction: a prospective, cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Rebecca F. Hamm ◽  
Sindhu K. Srinivas ◽  
Lisa D. Levine
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Black Women ◽  
Racial Disparities ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Labor Induction ◽  
Cesarean Birth ◽  
Birth Satisfaction ◽  
Labor Length

Abstract Background Decreased birth satisfaction has been associated with labor induction. Yet, there is a paucity of data evaluating risk factors for decreased satisfaction associated with labor induction. We aimed to determine what factors impact low birth satisfaction in labor induction and evaluate racial disparities in birth satisfaction. Methods We performed a prospective cohort study of women with term, singleton gestations undergoing labor induction at our institution from Jan 2018 to Jun 2018. Women completed the validated Birth Satisfaction Scale-Revised postpartum, which is subdivided into 3 domains: (1) quality of care provision, (2) women’s personal attributes, and (3) stress experienced during labor. A total satisfaction score above the mean was classified as “satisfied”, and below as “unsatisfied.” Domain and item scores were compared by race. Results Three hundred thirty of 414 (79.7%) eligible women were included. There was no significant difference in birth satisfaction by age, body mass index, Bishop score, or labor induction agent. Black women were 75% more likely to be unsatisfied than non-Black women (54.0% vs. 37.2%, OR 1.75 [95% CI 1.11–2.76], p = 0.037), nulliparas were 71% more  likely to be unsatisfied than multiparas (54.2% vs. 40.9%, OR 1.71 [95% CI 1.09–2.67], p = 0.019), and women whose labor resulted in cesarean birth were almost 3 times more likely to be unsatisfied than women with a vaginal birth (67.4% vs. 42.3%, OR 2.82 [95% CI 1.69–4.70], p < 0.001). Additionally, increased labor length quartile was associated with decreased satisfaction >(p = 0.003). By race, domain 3 scores, which reflect preparedness for labor, were lower for Black women. No differences were seen for domain 1 or 2. Conclusions Black race, cesarean birth, and increasing labor length were identified as risk factors for low birth satisfaction among women who underwent labor induction. Further studies should explore interventions to target women at risk for low birth satisfaction.

scholarly journals Mass incarceration and public health: the association between black jail incarceration and adverse birth outcomes among black women in Louisiana

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lauren Dyer ◽  
Rachel Hardeman ◽  
Dovile Vilda ◽  
Katherine Theall ◽  
Maeve Wallace
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Black Women ◽  
Low Birth Weight ◽  
Racial Disparities ◽  
Population Health ◽  
Birth Outcomes ◽  
Mass Incarceration ◽  
Interquartile Range ◽  
Adverse Birth Outcomes

Abstract Background A growing body of evidence is beginning to highlight how mass incarceration shapes inequalities in population health. Non-Hispanic blacks are disproportionately affected by incarceration and criminal law enforcement, an enduring legacy of a racially-biased criminal justice system with broad health implications for black families and communities. Louisiana has consistently maintained one of the highest rates of black incarceration in the nation. Concurrently, large racial disparities in population health persist. Methods We conducted a cross-sectional analysis of all births among non-Hispanic black women in Louisiana in 2014 to identify associations between parish-level (county equivalent) prevalence of jail incarceration within the black population and adverse birth outcomes (N = 23,954). We fit a log-Poisson model with generalized estimating equations to approximate the relative risk of preterm birth and low birth weight associated with an interquartile range increase in incarceration, controlling for confounders. In sensitivity analyses, we additionally adjusted for the parish-level index crime prevalence and analyzed regression models wherein white incarceration was used to predict the risk of adverse birth outcomes in order to quantify the degree to which mass incarceration may harm health above and beyond living in a high crime area. Results There was a significant 3% higher risk of preterm birth among black women associated with an interquartile range increase in the parish-level incarceration prevalence of black individuals, independent of other factors. Adjusting for the prevalence of index crimes did not substantively change the results of the models. Conclusion Due to the positive significant associations between the prevalence of black individuals incarcerated in Louisiana jails and estimated risk of preterm birth, mass incarceration may be an underlying cause of the persistent inequities in reproductive health outcomes experienced by black women in Louisiana. Not only are there economic and social impacts stemming from mass incarceration, but there may also be implications for population health and health inequities, including the persistence of racial disparities in preterm birth and low birth weight.

Racial Disparities in Pregnancy-associated Intimate Partner Homicide

2021 ◽  
pp. 088626052199083
Author(s):  
Aaron J. Kivisto ◽  
Samantha Mills ◽  
Lisa S. Elwood
Keyword(s):  
Black Women ◽  
Ethnic Minority ◽  
Racial Disparities ◽  
White Women ◽  
The United States ◽  
Intimate Partner ◽  
Intimate Partner Homicide ◽  
Homicide Victimization ◽  
Increased Risk ◽  
Racial Ethnic

Pregnancy-associated femicide accounts for a mortality burden at least as high as any of the leading specific obstetric causes of maternal mortality, and intimate partners are the most common perpetrators of these homicides. This study examined pregnancy-associated and non-pregnancy-associated intimate partner homicide (IPH) victimization among racial/ethnic minority women relative to their non-minority counterparts using several sources of state-level data from 2003 through 2017. Data regarding partner homicide victimization came from the National Violent Death Reporting System, natality data were obtained from the Centers for Disease Control and Prevention’s National Center for Health Statistics, and relevant sociodemographic information was obtained from the U.S. Census Bureau. Findings indicated that pregnancy and racial/ethnic minority status were each associated with increased risk for partner homicide victimization. Although rates of non-pregnancy-associated IPH victimization were similar between Black and White women, significant differences emerged when limited to pregnancy-associated IPH such that Black women evidenced pregnancy-associated IPH rates more than threefold higher than that observed among White and Hispanic women. Relatedly, the largest intraracial discrepancies between pregnant and non-pregnant women emerged among Black women, who experienced pregnancy-associated IPH victimization at a rate 8.1 times greater than their non-pregnant peers. These findings indicate that the racial disparities in IPH victimization in the United States observed in prior research might be driven primarily by the pronounced differences among the pregnant subset of these populations.

Chorioamnionitis after premature rupture of membranes in nulliparas undergoing labor induction: prostaglandin E2 vs. oxytocin

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Moti Gulersen ◽  
Cristina Zottola ◽  
Xueying Li ◽  
David Krantz ◽  
Mariella DiSturco ◽  
...  
Keyword(s):  
Prostaglandin E2 ◽  
Neonatal Intensive Care ◽  
Labor Induction ◽  
Cervical Ripening ◽  
Time Interval ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Chi Squared ◽  
Unfavorable Cervix ◽  
Cox Proportional Hazard Regression

Abstract Objectives To assess the risk of chorioamnionitis in nulliparous, term, singleton, vertex (NTSV) pregnancies with premature rupture of membranes (PROM) and an unfavorable cervix undergoing labor induction with either prostaglandin E2 (PGE2) or oxytocin only. Methods Retrospective cohort of NTSV pregnancies presenting with PROM who underwent labor induction with either PGE2 (n=94) or oxytocin (n=181) between October 2015 and March 2019. The primary outcome of chorioamnionitis was compared between the two groups. Statistical analysis included Chi-squared and Wilcoxon rank-sum tests, as well as logistic regression. For time to delivery, a Cox proportional hazard regression was used to determine the hazard ratio (HR) and adjusted HR (aHR). Results Baseline characteristics were similar between the two groups. Cervical ripening with PGE2 was associated with an increased rate of chorioamnionitis (18.1 vs. 6.1%; aOR 4.14, p=0.001), increased neonatal intensive care unit admissions (20.2 vs. 9.9%; aOR 2.4, p=0.02), longer time interval from PROM to delivery (24.4 vs. 17.9 h; aHR 0.56, p=<0.0001), and lower incidence of meconium (7.4 vs. 14.4%; aOR 0.26, p=0.01), compared to the oxytocin group. Conclusions Based on our data, the use of oxytocin appears both superior and safer compared to PGE2 in NTSV pregnancies with PROM undergoing labor induction.

Determinants of Racial Disparities in Female Incarceration Rates, 2000–2018

2021 ◽  
pp. 003464462110510
Author(s):  
Samuel L. Myers ◽  
William J. Sabol ◽  
Man Xu
Keyword(s):  
Black Women ◽  
Racial Disparities ◽  
African American Women ◽  
White Women ◽  
National Research Council ◽  
The United States ◽  
White Female ◽  
Opioid Use ◽  
Incarceration Rate ◽  
Women In Prison

In The Growth of Incarceration in the United States, the National Research Council documents the large and persistent racial disparities in imprisonment that accompanied the more than quadrupling of the U.S. incarceration rate since the 1980s. Largely unnoticed by policy makers and opinion leaders in recent years is an unprecedented decrease in the number of African American women incarcerated at the same time that the number of white women in prison has grown to new heights. The result of these recent changes is a near convergence in black-white female incarceration rates from 2000 to 2016. In some states, the changes occurred abruptly and almost instantaneously. In other states, the convergence has been gradual. We find that changes in the population composition—the fraction of the population that is black—was the major contributor to the decline in the disparity among women. We also find that race-specific differences in drug overdose deaths stemming from the recent increases in opioid use lowered the disparity by increasing the white female imprisonment rate and lowering it for black women.

Distant metastases after diagnosis: Racial disparities in breast cancer outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1084-1084
Author(s):  
Julia Blanter ◽  
Ilana Ramer ◽  
Justina Ray ◽  
Emily J. Gallagher ◽  
Nina A. Bickell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Black Women ◽  
Racial Disparities ◽  
Late Stage ◽  
White Women ◽  
Univariate Analysis ◽  
Distant Metastases ◽  
Stage At Diagnosis

1084 Background: Black women diagnosed with breast cancer are more likely to have a poor prognosis, regardless of breast cancer subtype. Despite having a lower incidence rate of breast cancer when compared to white women, black women have the highest breast cancer death rate of all racial and ethnic groups, a characteristic often attributed to late stage at diagnosis. Distant metastases are considered the leading cause of death from breast cancer. We performed a follow up study of women with breast cancer in the Mount Sinai Health System (MSHS) to determine differences in distant metastases rates among black versus white women. Methods: Women were initially recruited as part of an NIH funded cross-sectional study from 2013-2020 to examine the link between insulin resistance (IR) and breast cancer prognosis. Women self-identified as black or white race. Data was collected via retrospective analysis of electronic medical records (EMR) between September 2020-January 2021. Distant metastases at diagnosis was defined as evidence of metastases in a secondary organ (not lymph node). Stage at diagnosis was recorded for all patients. Distant metastases after diagnosis was defined as evidence of metastases at any time after initiation of treatment. Univariate analysis was performed using Fisher’s exact test, multivariate analysis was performed by binary logistic regression, and results expressed as odds ratio (OR) and 95% confidence interval (CI). A p value <0.05 was considered statistically significant. Results: We identified 441 women enrolled in the IR study within the MSHS (340 white women, 101 black women). Median follow up time for all women was 2.95 years (median = 3.12 years for white and 2.51 years for black women (p=0.017)). Among these patients, 11 developed distant metastases after diagnosis: 4 (1.2%) white and 7 (6.9%) black (p=0.004). Multivariate analysis adjusting for age, race and stage at diagnosis revealed that black women were more likely to have distant metastasis (OR 5.8, CI 1.3-25.2), as were younger women (OR for age (years) 0.9, CI 0.9-1.0), and those with more advanced stage at diagnosis. Conclusions: Black women demonstrated a far higher percentage of distant metastases after diagnosis even when accounting for age and stage. These findings suggest that racial disparities still exist in the development of distant metastases, independent from a late-stage diagnosis. The source of existing disparities needs to be further understood and may be found in surveillance, treatment differences, or follow up.

scholarly journals Racial Disparities in Women's Mobility out of Retail and Service Occupations

2019 ◽  
Author(s):  
Liana Christin Landivar ◽  
Julia Beckhusen
Keyword(s):  
Black Women ◽  
Women Workers ◽  
Educational Attainment ◽  
Racial Disparities ◽  
Race And Ethnicity ◽  
Hispanic Women ◽  
Occupational Mobility ◽  
Program Participation ◽  
Job Tenure ◽  
Black And White

Nearly 40 million workers are employed in retail and service occupations. While the average age and educational attainment of workers in these occupations has increased significantly since the 1970s, many of these occupations offer low wages, along with limited fringe benefits and opportunities for advancement. These occupations also employ a disproportionate share of Black and Hispanic women. Using longitudinal data from the 2004 and 2008 Survey of Income and Program Participation which provide occupational data over a four year timespan, we evaluate the prevalence of occupational mobility by sex, race, and ethnicity. This research shows there are racial disparities in occupational mobility, with Black and Hispanic women less likely to exit retail and service occupations than White, non-Hispanic women. Educational attainment increased the likelihood of occupational mobility. Hispanic women’s lower levels of educational attainment depressed their occupational mobility, while longer job tenure increased the likelihood they would be occupationally mobile. Differences in human capital and job tenure did not explain mobility disparities between Black and White, non-Hispanic women. However, unionization reduced occupational mobility and partly accounts for Black women’s lower rates of mobility. Black women were more likely to be unionized and unionization was associated with decreased occupational mobility among women. Workers in unionized retail and service occupations earned higher wages, reducing the incentive to leave and lowering their occupational mobility rate.

scholarly journals Development and psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R)

Midwifery ◽  
2014 ◽  
Vol 30 (6) ◽  
pp. 610-619 ◽  
Author(s):  
Caroline J. Hollins Martin ◽  
Colin R. Martin
Keyword(s):  
Psychometric Properties ◽  
Satisfaction Scale ◽  
Birth Satisfaction
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