Factors influencing women's perceptions of shared decision making during labor and delivery: Results from a large-scale cohort study of first childbirth.
Laura B Attanasio, Katy B Kozhimannil, Kristen H Kjerulff
PMID 29339041WHAT IT FOUND
First-time mothers who had labor induction, assisted vaginal delivery, or unplanned cesarean were less likely to report high involvement in birth decisions.
Black women, less educated women, and those without private insurance also reported lower involvement.
Key findings
01Women with assisted vaginal delivery and unplanned cesarean delivery had lower adjusted odds of high shared decision making than women with spontaneous vaginal delivery, and labor induction was independently associated with lower odds.
02Black women had lower adjusted odds of high shared decision making than White women, while women with a Bachelor's degree had higher adjusted odds than women with high school or less and women with non-private insurance had lower adjusted odds.
03Predicted probability of high shared decision making was 0.28 for Black women with cesarean delivery versus 0.61 for Black women with vaginal delivery; for White women it was 0.55 versus 0.68.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The shared decision making measure was a new 6-item true/false scale. It was highly skewed, with 64.0% of women scoring the highest possible value. Women's own reports of involvement may be higher than observer reports. If that happened here, the associations may be underestimates. The cohort over-represents women from more socially privileged groups compared with first-time mothers in Pennsylvania. Results may not generalize to all childbearing women. Planned cesarean deliveries were excluded. The study does not describe decision making in that context. The study is observational. It cannot show that procedures caused lower perceived shared decision making. Latina women were grouped broadly. The paper notes substantial heterogeneity among Latina subgroups. Cesarean satisfaction could reflect unmet preference for vaginal birth, though models controlled for preference alignment.
Declared interests
The supplied text lists NIH extramural research support. It does not include a separate author conflicts-of-interest statement.
The easy way to misread this
Do not conclude that labor induction, assisted vaginal delivery, or cesarean delivery caused women to feel less involved. This was an observational study of women's perceptions, and the scale measured perceived involvement rather than the actual decision-making process.