Primary Cesarean Delivery Patterns among Women with Physical,Sensory, or Intellectual Disabilities |
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| Institution: | 1. Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon;2. National Institute of Public Health, Center for Health Systems Research, Cuernavaca, Mexico;3. Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon;1. Women''s College Research Institute, Women''s College Hospital, Toronto, Ontario;2. Institute for Clinical Evaluative Sciences, Toronto, Ontario;3. Department of Psychiatry, University of Toronto, Toronto, Ontario;4. Centre for Addiction and Mental Health, Toronto, Ontario;5. School of Psychology, University of Ottawa, Ottawa, Ontario;1. The Lurie Institute for Disability Policy, The Heller School of Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 01453, USA;2. Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury, MA 01545, USA;3. Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, Room 901B, Boston, MA 02114, USA;4. Center for Nursing Research, Villanova University, 800 Lancaster Avenue, Villanova, PA 19085, USA;1. Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, Massachusetts;2. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts;3. Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts;4. The Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts;1. Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, Massachusetts;2. Department of Medicine, Harvard Medical School, Boston, Massachusetts;3. Center for Nursing Research, Villanova University College of Nursing, Villanova, Pennsylvania;4. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts;5. Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts |
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| Abstract: | BackgroundLittle is known about the relationship between disability and mode of delivery. Prior research has indicated elevated risk of cesarean delivery among women with certain disabilities, but has not examined patterns across multiple types of disability or by parity.ObjectiveThis study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery.MethodsWe conducted a retrospective cohort study of all deliveries in California from 2000 to 2010 using linked birth certificate and hospital discharge data. We identified physical, sensory, and intellectual and developmental disabilities using International Classification of Diseases, 9th revision, clinical modification codes. We used logistic regression to examine the association of these disabilities and primary cesarean delivery, controlling for sociodemographic characteristics and comorbidities, and stratified by parity.ResultsIn our sample, 0.45% of deliveries (20,894/4,610,955) were to women with disabilities. A greater proportion of women with disabilities were nulliparous, had public insurance, and had comorbidities (e.g., gestational diabetes) compared with women without disabilities (p < .001 for all). The proportion of primary cesarean in women with disabilities was twice that in women without disabilities (32.7% vs. 16.3%; p < .001; adjusted odds ratio, 2.05; 95% confidence interval, 1.94–2.17). The proportion of deliveries by cesarean was highest among women with physical disabilities due to injuries compared with women without disabilities (57.8% vs. 16.3%; p < .001; adjusted odds ratio, 6.83; 95% confidence interval, 5.46–8.53).ConclusionsWomen across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type. More attention is needed to this population to ensure better understanding of care practices that may impact maternal and perinatal outcomes. |
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