262 Risk of primary cesarean delivery among non-english speaking nulliparous women

Abstract

Demographic factors such as maternal age, race, ethnicity, and socioeconomic status are known to affect rates of primary Cesarean delivery. However, effect of a patient’s primary language on rate of Cesarean is unknown. We sought to examine the association between rate of primary unscheduled Cesarean delivery and preferred patient language. A retrospective cohort study was conducted at a large urban medical center between 8/2018 and 1/2020. Inclusion criteria were nulliparity, full term gestation, and having no obstetric or medical contraindication to vaginal delivery. Multiparous women, women with medical contraindications to vaginal delivery, scheduled cesarean deliveries, preterm and multifetal gestations were excluded from the analysis. We used multivariable analyses to evaluate language differences in risk of cesarean delivery. 1316 women were eligible for this study. The overall rate of cesarean delivery was 27.9%. Of this cohort, 76.7% of patients preferred English, 18% Spanish and 5.3% other (all other languages). Spanish and other-speaking women had significantly higher odds of undergoing Cesarean compared to English-speaking women (odds ratio: 1.45; 95% CI: 1.10, 1.91), which remained significant when controlling for factors such as maternal age, race, ethnicity, BMI, insurance type, maternal co-morbidities, labor induction, and infant birthweight (adjusted odds ratio: 1.63; 95% CI: 1.15, 2.32). Interpreter use was documented in 52.1% of non-English speaking admissions. Cesarean delivery rates differ by patient’s preferred language. Specifically, primary cesarean delivery rates were found to be significantly higher among non-English speaking nulliparous women. This difference may be reflective of lack of effective communication during clinical encounters, provider bias, or other factors and should be further studied. Interpreter services should be utilized and documented effectively.View Large Image Figure ViewerDownload Hi-res image Download (PPT)