Date on Master's Thesis/Doctoral Dissertation
Health Promotion and Behavioral Sciences
Public Health Sciences with a specialization in Health Promotion, PhD
Cesarean delivery; quality of care; person-centered care; equitable care; socio-cultural contexts
The cesarean delivery rate has increased and accounts for a third of pregnancies in the U.S., especially among marginalized women. This study applied a newly developed conceptual model to identify potential areas of influence that could reduce rates of cesarean deliveries. The Giving Voice to Mothers - United States data was used for analyses to predict covariates associated with having a cesarean delivery vs. spontaneous vaginal delivery (n=1,876). Significant covariates were determined and included the following: having a prior cesarean delivery (OR: 14.11, 95% CI: 7.99 - 24.90); more than one child (OR: 0.21, 95% CI: 0.13 - 0.35); elevated pregnancy risk (OR: 2.22 - 4.90, 95% CI: 2.22 - 4.90); doctor as perinatal care provider (OR: 2.25, 95% CI: 1.40 - 3.61); and receiving disrespectful perinatal care (OR: 2.16, 95% CI: 1.13 - 4.12). Significant covariates associated with race/ethnicity with white women as the reference group included the following: Asian women had higher odds of having a prior cesarean delivery (OR: 2.59, 95% CI: 1.31 - 5.12) and doctor as their perinatal care provider (OR: 2.31, 95% CI: 1.22 - 4.35); Black women had higher odds of having one or more child (OR: 2.15, 95% CI: 1.11 - 4.14); and Hispanic (OR: 1.89, 95% CI: 1.04 - 3.45) and Indigenous (OR: 3.17, 95% CI: 1.34 - 7.48) women had higher odds of receiving disrespectful perinatal care. Cesarean delivery rates could reduce by intervening at individual and interpersonal levels of influence that incorporate fewer medical interventions and improved patient-provider interactions.
Story, Alice M., "Person-centered decision-making and socio-cultural contexts influencing cesarean deliveries: a national analysis." (2022). Electronic Theses and Dissertations. Paper 3836.
Retrieved from https://ir.library.louisville.edu/etd/3836