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Am J Perinatol 2024; 41(S 01): e1241-e1247
DOI: 10.1055/a-2008-8540
Original Article

Rate of Primary Cesarean Delivery by Language Preference among Nulliparas

Lizelle Comfort
1   Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Meaghan Jain 
1   Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Haotian Wu
2   Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
,
Lisa Nathan
3   Department of Obstetrics, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
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Funding None.
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Abstract

Objective Sociodemographic factors such as race/ethnicity and socioeconomic status affect primary cesarean delivery rates. Language is associated with disparate health care outcomes but has not been well studied in obstetrics. We examined the association between primary unscheduled cesarean delivery rate and preferred patient language.

Study Design A retrospective cohort study was conducted at an urban medical center between January 2017 and January 2020. Nulliparous women with early or full-term gestation and having no obstetric or medical contraindication to vaginal delivery were included. We used multivariable linear and logistic regressions to evaluate language differences in cesarean delivery odds and indication for cesarean.

Results Of the 1,314 eligible women, 76.8% of patients preferred English, 17.8% Spanish, and 5.4% other languages. Overall cesarean delivery rate was 27.6%. Controlling for age, race/ethnicity, body mass index, insurance, gravidity, pregnancy comorbidities, labor induction, and infant birth weight, Spanish- and other language-speaking women had significantly higher odds of undergoing cesarean compared with English-speaking women (adjusted odds ratio [OR]: 1.75; 95% confidence interval [CI]: 1.25, 2.46). Relative proportions of indications for cesarean did not differ by language group. Documented interpreter use was an effect modifier on the relationship between language preference and cesarean (OR with interpreter use: 2.89, 95% CI: 1.90, 4.39).

Conclusion Primary cesarean delivery rates were significantly higher among nulliparous women who prefer languages other than English. This difference may reflect lack of communication, provider bias or discrimination, or other factors, and should be further studied. Interpreter services should be routinely utilized and documented effectively.

Key Points

  • Women who prefer languages other than English had higher odds of cesarean.

  • Indication for cesarean did not differ by language.

  • Interpreter use did not reduce risk for cesarean.

Keywords

patient language - disparities - obstetrics - cesarean delivery - professional interpreter

Authors' Contributions

L.C. developed the project, wrote and submitted the IRB, performed data collection and analysis, and wrote the manuscript; M.J. performed data collection and analysis, wrote and edited the manuscript; H.W. performed statistical design, power calculations and statistical analysis, wrote the methods portion of the manuscript, and created the tables; L.N. was the PI of the project and assisted in project design and development, provided institutional labor and delivery data and statistics, wrote a significant portion of the manuscript including the discussion, and edited the manuscript in various stages.




Publication History

Received: 19 March 2022

Accepted: 16 December 2022

Accepted Manuscript online:
06 January 2023

Article published online:
15 February 2023

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