Abstract
Objectives
While some medical indications for cesarean delivery are clear, subjective provider and patient factors contribute to the rising cesarean delivery rates and marked disparities between racial/ethnic groups. We aimed to determine the association between language preference and risk of primary cesarean delivery.
Methods
We conducted a retrospective cohort study of nulliparous, term, singleton, vertex (NTSV) deliveries of patients over 18 years old from 2011–2016 at an academic medical center, supplemented with data from the Massachusetts Department of Public Health. We used modified Poisson regression with robust error variance to calculate risk ratios for cesarean delivery between patients with English language preference and other language preference, with secondary outcomes of Apgar score, maternal readmission, blood transfusion, and NICU admission.
Results
Of the 11,298 patients included, 10.3% reported a preferred language other than English, including Mandarin and Cantonese (61.7%), Portuguese (9.7%), and Spanish (7.5%). The adjusted risk ratio for cesarean delivery among patients with a language preference other than English was 0.85 (95% CI 0.72–0.997; p = 0.046) compared to patients with English language preference. No significant differences in risk of secondary outcomes between English and other language preference were found.
Discussion
After adjusting for confounders, this analysis demonstrates a decreased risk of cesarean delivery among women who do not have an English language preference at one institution. This disparity in cesarean delivery rates in an NTSV population warrants future research, raising the question of what clinical and social factors may be contributing to these lower cesarean delivery rates.
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Data Availability
Deidentified datasets may be made available after written request to the corresponding author and pending any necessary institutional review board approval.
Code Availability
Data analysis was conducted using Stata v12.1 (StataCorp, College Station, Texas, 2018).
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Funding
This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers.
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KMS, AMM, MRH, and RLM designed the study. KMS, AMM, MRH, LC, YC, TG, and RLM contributed to the acquisition, analysis, or interpretation of data. KMS drafted the manuscript. KMS, AMM, MRH, LC, YC, TG, and RLM provided substantive revisions and approval of the final manuscript.
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This study was approved by the Institutional Review Boards of the Beth Israel Deaconess Medical Center and the Massachusetts Department of Public Health.
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Schaefer, K.M., Modest, A.M., Hacker, M.R. et al. Language Preference and Risk of Primary Cesarean Delivery: A Retrospective Cohort Study. Matern Child Health J 25, 1110–1117 (2021). https://doi.org/10.1007/s10995-021-03129-z
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DOI: https://doi.org/10.1007/s10995-021-03129-z