Table 1: Baseline demographics of study sample: women undergoing labor induction
|
|
Age a
|
29[25-34]
|
Race
|
|
Black
|
213(64.6)
|
Non-Black
|
117(35.4)
|
Ethnicity
|
|
Non-Hispanic
|
316(95.8)
|
Hispanic
|
14(4.2)
|
Insurance Type
|
|
Private/Individual
|
152(46.1)
|
Medicaid/Uninsured
|
178(53.9)
|
BMI at Delivery
|
|
<25
|
24(7.3)
|
25-29.9
|
84(25.5)
|
30-34.9
|
103(31.2)
|
35-39.9
|
53(16.1)
|
≥40
|
66(20.0)
|
Number of prenatal visits a
|
11[8-13]
|
Parity
|
|
Nulliparous
|
203(61.5)
|
Multiparous
|
127(38.5)
|
Pregestational diabetes
|
8(2.4)
|
Chronic hypertension
|
23(7.0)
|
Indication for labor induction
|
|
Maternal indications b
|
131 (39.7)
|
Fetal indications c
|
114 (34.6)
|
Elective/ Other d
|
49(14.9)
|
Late term
|
36(10.9)
|
Gestational Age at Delivery (weeks) a
|
39[38-40]
|
Modified Bishop Score at start of labor induction a
|
2[1-3]
|
Cervical dilation at start of labor induction
|
2[0-2]
|
Labor induction agent
|
|
Misoprostol alone
|
11(3.3)
|
Foley alone
|
15(4.6)
|
Foley + Misoprostol
|
265(80.3
|
Foley + Pitocin
|
37(11.2)
|
Other
|
2(0.6)
|
Regional Anesthesia
|
312(94.6)
|
Data are presented as n(%) unless otherwise indicated.
a. Median [Interquartile Range]
b. Examples include: chronic hypertension, gestational hypertension, preeclampsia, diabetes, renal disease, history of venous thromboembolism, cardiac disease or other chronic medical condition where labor induction was recommended
c. Examples include: Oligohydramnios, intrauterine growth restriction, abnormality on fetal testing
d. Examples of “other” include: history of an intrauterine fetal demise, vaginal bleeding at term, cholestasis
Table 2: Risk factors for decreased birth satisfaction among women undergoing labor induction
|
Unsatisfied (n=162)
|
Satisfied (n=168)
|
p-value
|
Age a
|
29[24-34]
|
29[25-34]
|
0.53
|
Race
|
|
|
0.02
|
Black(n=213)
|
115(54.0)
|
98(46.0)
|
|
Non-Black(n=117)
|
47(40.2)
|
70(59.8)
|
|
Insurance Type
|
|
|
0.31
|
Private/Individual(n=152)
|
70(46.1)
|
82(54.0)
|
|
Medicaid/Uninsured(n=178)
|
92(51.7)
|
86(48.3)
|
|
BMI
|
|
|
0.99
|
<25(n=24)
|
11(45.8)
|
13(54.2)
|
|
25-29.9(n=84)
|
40(47.6)
|
44(52.4)
|
|
30-34.9(n=103)
|
51(49.5)
|
52(50.5)
|
|
35-39.9(n=53)
|
26(49.1)
|
27(50.9)
|
|
> or equal to 40(n=66)
|
34(51.5)
|
32(48.5)
|
|
Number of Prenatal Visits a
|
10[8-13]
|
11[9-13]
|
0.21
|
Parity
|
|
|
0.02
|
Nulliparous(n=203)
|
110(54.2)
|
93(45.8)
|
|
Multiparous(n=127)
|
52(40.9)
|
75(59.1)
|
|
Indication for labor induction
|
|
|
0.31
|
Maternal indications(n=131) b
|
58(44.3)
|
73(55.7)
|
|
Fetal indications (n=114) c
|
56(49.1)
|
58(50.9)
|
|
Elective/Other(n=49) d
|
26(53.1)
|
23(46.9)
|
|
Late term(n=36)
|
22(61.1)
|
14(38.9)
|
|
Gestational Age at Delivery (weeks) a
|
39[38-40]
|
39[38-40]
|
0.09
|
Modified Bishop Score at labor induction a
|
3[1-3]
|
2[2-3]
|
0.84
|
Cervical dilation at labor induction a
|
1-2[0-2]
|
2[0-2]
|
0.41
|
Labor induction Method
|
|
|
0.48
|
Misoprostol alone (n=11)
|
5(45.5)
|
6(54.6)
|
|
Foley alone (n=15)
|
9(60.0)
|
6(40.0)
|
|
Foley + Misoprostol (n=265)
|
126(47.6)
|
139(52.5)
|
|
Foley + Pitocin (n=37)
|
20(54.1)
|
17(46.0)
|
|
Other (n=2)
|
2(100)
|
0(0)
|
|
Mode of Delivery
|
|
|
<0.0001
|
Vaginal Delivery (n= 241)
|
102(42.3)
|
139(57.7)
|
|
Cesarean Delivery (n=89)
|
60(67.4)
|
29(32.6)
|
|
Length of labor (h) a
|
18.3[12.5-23.1]
|
14.6[10.6-21.2]
|
0.0013
|
Indication for Cesarean
|
|
|
0.65
|
Elective/Other(n=7)
|
5(71.4)
|
2(28.6)
|
|
Failed labor induction/Arrest of active phase(n=37)
|
26(70.3)
|
11(29.7)
|
|
Arrest of descent/Failed operative delivery (n=13)
|
10(77.0)
|
3(23.1)
|
|
Fetal heart rate indications(n=32)
|
19(59.4)
|
13(40.6)
|
|
Regional Anesthesia
|
|
|
0.17
|
Yes(n=312)
|
156(50.0)
|
156(50.0)
|
|
No(n=18)
|
6(33.3)
|
12(66.7)
|
|
Data are presented as the row n(%) unless otherwise indicated
a Row Median [Interquartile Range]
b. Examples include: chronic hypertension, gestational hypertension, preeclampsia, diabetes, renal disease, history of venous thromboembolism, cardiac disease or other chronic medical condition where labor induction was recommended
c. Examples include: Oligohydramnios, intrauterine growth restriction, abnormality on fetal testing
d. Examples of “other” include: history of an intrauterine fetal demise, vaginal bleeding at term, cholestasis
Table 3: Multivariate analysis of factors associated with low maternal birth satisfaction during labor induction
Risk Factor
|
|
aOR
|
95%CI
|
p-value
|
Race
|
Black
|
REF
|
-
|
-
|
|
Non-Black
|
1.78
|
1.10-2.90
|
0.02
|
Mode of Delivery
|
Vaginal
|
REF
|
-
|
-
|
|
Cesarean
|
0.46
|
0.27-0.79
|
0.005
|
Labor Length Quartile
|
1 (<11.4 hours)
|
REF
|
-
|
-
|
|
2 (11.4-16.1 hours)
|
0.77
|
0.40-1.48
|
0.44
|
|
3 (16.2-22.0 hours)
|
0.40
|
0.20-0.76
|
0.006
|
|
4 (≥22.1 hours)
|
0.47
|
0.24-0.91
|
0.03
|
REF=reference group
|
Table 4: Demographic and clinical outcomes of study group of women undergoing labor induction by race
|
Black
(n=213)
|
Non-Black
(n=117)
|
p-value
|
Age a
|
26[23-31]
|
32[30-36]
|
<0.0001
|
Insurance Type
|
|
|
<0.0001
|
Private/Individual
|
49(23.0)
|
103(88.0)
|
|
Medicaid/Uninsured
|
164(77.0)
|
14(12.0)
|
|
BMI
|
|
|
0.001
|
<25
|
13(6.1)
|
11(9.4)
|
|
25-29.9
|
42(19.7)
|
42(35.9)
|
|
30-34.9
|
65(30.5)
|
38(32.5)
|
|
35-39.9
|
40(18.8)
|
13(11.1)
|
|
> or equal to 40
|
53(24.9)
|
13(11.1)
|
|
Number of Prenatal Visits a
|
10[7-12]
|
12[10-13]
|
<0.0001
|
Parity
|
|
|
<0.0001
|
Nulliparous
|
114(53.5)
|
89(76.1)
|
|
Multiparous
|
99(46.5)
|
28(23.9)
|
|
Indication for labor induction
|
|
|
0.012
|
Maternal b
|
83(39.0)
|
48(41.0)
|
|
Fetal c
|
85(39.9)
|
29(24.8)
|
|
Elective/Other d
|
28(13.2)
|
21(18.0)
|
|
Late term
|
17(8.0)
|
19(16.2)
|
|
Gestational Age at Delivery (weeks) a
|
39[38-40]
|
39[38-40]
|
0.06
|
Scheduled IOL
|
90(42.3)
|
70(59.8)
|
0.002
|
Modified Bishop Score at labor induction a
|
2[2-3]
|
3[1-4]
|
0.04
|
Cervical dilation at labor induction a
|
1-2[0-2]
|
1-2[0-2]
|
0.86
|
Labor induction Method
|
|
|
0.25
|
Misoprostol alone
|
8(3.8)
|
3(2.6)
|
|
Foley alone
|
10(4.7)
|
5(4.3)
|
|
Foley + Misoprostol
|
164(77.0)
|
101(86.3)
|
|
Foley + Pitocin
|
29(13.6)
|
8(6.8)
|
|
Other
|
2(0.9)
|
0(0.0)
|
|
Mode of Delivery
|
|
|
0.013
|
Vaginal Delivery
|
146(68.5)
|
95(81.2)
|
|
Cesarean Delivery
|
67(31.5)
|
22(18.8)
|
|
Length of labor (hrs) a
|
15.9[10.6-22.3]
|
16.4[12.4-21.7]
|
0.29
|
Labor Length Quartile
|
|
|
0.009
|
1(<11.4hrs)
|
63(29.6)
|
19(16.2)
|
|
2(11.4-16.1hrs)
|
47(22.1)
|
36(30.8)
|
|
3(16.2-22.0hrs)
|
46(21.6)
|
37(31.6)
|
|
4(≥22.1hrs)
|
57(26.8)
|
25(21.4)
|
|
Indication for Cesarean
|
|
|
<0.0001
|
Elective/Other
|
5(7.5)
|
2(9.1)
|
|
Failed labor induction/Arrest of active phase
|
33(49.3)
|
4(18.2)
|
|
Arrest of descent/Failed operative delivery
|
3(4.5)
|
10(45.5)
|
|
Fetal heart rate indications
|
26(38.8)
|
6(27.3)
|
|
Regional Anesthesia
|
200(93.9)
|
112(95.7)
|
0.48
|
a Median [Interquartile Range]
b. Examples include: chronic hypertension, gestational hypertension, preeclampsia, diabetes, renal disease, history of venous thromboembolism, cardiac disease or other chronic medical condition where labor induction was recommended
c. Examples include: Oligohydramnios, intrauterine growth restriction, abnormality on fetal testing
d. Examples of “other” include: history of an intrauterine fetal demise, vaginal bleeding at term, cholestasis
Table 5: Birth Satisfaction Scale-Revised scores for women undergoing labor induction by race
|
Black
|
Non-Black
|
p-value
|
Total BSS-R (out of 50) a
|
38[34-42]
|
40[36-43]
|
0.02
|
Domain #1: Stress Experienced During Labor (out of 20) a
|
14[12-16]
|
14[12-16]
|
0.40
|
“I came through childbirth virtually unharmed.”
|
90.1
|
80.3
|
0.01
|
“I thought my labor was excessively long.”
|
34.3
|
21.4
|
0.01
|
“I found giving birth a distressing experience.”
|
31.5
|
26.5
|
0.35
|
“I was not distressed at all during labor.”
|
35.2
|
21.4
|
0.01
|
Domain #2: Quality of Care Provision (out of 20) a
|
18[16-20]
|
19[17-20]
|
0.06
|
“The delivery room staff encouraged me to make decisions about how I wanted my birth to progress.”
|
83.6
|
88.0
|
0.28
|
“I felt well supported by staff during my labor and delivery.”
|
94.4
|
97.4
|
0.20
|
“The staff communicated well with me during labor.”
|
96.7
|
95.7
|
0.65
|
“I was satisfied with how I delivered.”
|
85.5
|
88.9
|
0.38
|
Domain #3: Women’s personal attributes (out of 10) a
|
6[5-8]
|
7[6-9]
|
0.01
|
“I felt very anxious during my labor and delivery.”
|
58.2
|
39.3
|
0.001
|
“I felt out of control during my birth experience.”
|
16.4
|
15.4
|
0.80
|
Results shown are the percentage of women who agreed or strongly agreed with the statement, unless otherwise stated.
a Median [Interquartile Range]