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

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.