The Patient-Provider Relationship and Use of Labor Induction and Cesarean Delivery



 DESCRIPTION (provided by applicant): Overuse of care occurs when patients receive medical services that are unnecessary or for which the risks are greater than the benefits. Decisions about medical services, treatments, and procedures are made in consultation between provider and patient, but little is known about how the patient-provider relationship may relate to overuse. Maternity care is an important context for understanding the connection between the overuse of services and the patient-provider relationship for three reasons. First, maternity care is both very common and costly: nearly 4 million women give birth in the United States each year, and childbirth is the most common reason for hospitalization. Second, experts in maternity care have identified overuse of cesarean delivery and, to a lesser degree, labor induction as major challenges to be addressed. During the past several decades, medical interventions during birth have become increasingly common, with nearly a third of births (32.8%) delivered by cesarean section, and over 20% of births following an induction of labor. Third, pregnant women generally have multiple interactions with their providers during prenatal care and are able to consider and seek information about medical decisions in advance of the need for care. Yet, limited research has examined the relationship between pregnant women and their providers and how this shapes decision-making and care utilization in childbirth. Moreover, women are not all at equal risk of receiving an unnecessary medical procedure such as a cesarean during childbirth; recent studies suggest that black women and less-educated women actually have higher rates of cesarean delivery than their white and more-educated counterparts, after accounting for medical complications, but the reasons for this are not understood. Using two sources of survey data from women who recently gave birth, this project examines 1) the role of the patient-provider relationship in use of labor induction and cesarean delivery, and 2) whether the patient-provider relationship accounts for race/ethnicity and socioeconomic status differences in use of these procedures. This work will make two major contributions. First, it will provide initial evidence of how the characteristics of the patient-provider relationship - particularly those that are consistent with patient-centered care - may contribute to or be protective against the overuse of procedures in childbirth. Second, this study will help clarify the role of the patient-provider relationship in explaining racial/ethnic and SES differences in childbirth-related procedures. The proposed research is consistent with AHRQ's strategic research goals of improving quality and effectiveness, and focuses on women, low-income and minority groups, which are AHRQ priority populations.