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Medical indications for primary cesarean delivery in women with and without disabilities

posted on 18.03.2019 by Frances Biel, Blair Darney, Aaron Caughey, Willi Horner-Johnson

Background: Prior research has found that women with disabilities are more likely to deliver by cesarean than are women without disabilities. It is not clear whether all of the cesarean deliveries among women with disabilities are medically necessary.

Objectives: To examine the associations between maternal disability status and type, mode of delivery, and medical indications for cesarean delivery in California deliveries.

Study design: Retrospective cohort study of all nulliparous births in California between 2000 and 2012. We classified births as to whether or not women underwent a trial of labor and determined if medical indications for cesarean delivery were present. Multivariable logistic regression models examined the association of disability with trial of labor and indications for cesarean delivery.

Results: Women with disabilities had lower odds of having a labored delivery, compared to women without disabilities (adjusted odds ratio (aOR) = 0.45, 95% confidence interval (CI) 0.41–0.49). In the sample of women who labored (90.5% of total), women with disabilities were more likely to have a medical indication for cesarean delivery (aOR = 1.15, 95% CI 1.10–1.21) and were more likely to have a cesarean delivery (aOR = 1.46, 95% CI = 1.38–1.54). In the subsample of unlabored cesarean deliveries, women with disabilities were less likely to have documented medical indications for cesarean delivery (aOR = 0.45, 95% CI = 0.41–0.50).

Conclusions: Women with disabilities were less likely to labor, and these unlabored cesarean deliveries were less likely to have a medical indication for cesarean, compared to women without disabilities.


The research reported here was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institute of Health under award Number R21HD081309 (Horner-Johnson, P.I.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Support for Horner-Johnson’s time was provided by grant number K12HS022981 from the Agency for Health Care Research and Quality (Guise, PI). The funding agencies had no role in the conduct of the research or preparation of the manuscript for submission.