Psychosocial correlates to labor outcomes between English and Spanish speaking patients

Authors: Katherine Murphy, MD; Heidi Preis, PhD; Alexa Letizia, BS; Francesca DeIseo-Frechette

Background:

Peripartum as well as pre-existing depression and anxiety have significant clinical impacts on pregnancy and labor outcomes. Currently, the only screening tool that is standardly utilized is the Edinburgh Postnatal Depression Scale (EPDS). Despite mood disorders such as depression and anxiety having known impacts on pregnancy and labor, little has been studied on maternal request for a cesarean section once labor, trial of labor after a cesarean, or induction has started.

Objective:

The purpose of this study was to determine if elevated EDPS scores or elevated vulnerability factors affect the rate of maternal request for cesarean section once labor, trial of labor after a cesarean, or induction has started.

Study Design:

This case-control cohort chart review study included all patients who completed the PROMOTE between January 2023 and June 2024 during their first prenatal visit in Spanish (n= 138) and English-speaking patients (n=138) that were matched on parity (nulliparous vs. multiparous) and on month of first prenatal visit.

Results:

A total of 249 participants were included. The mean age at survey was 30.48 years (SD = 5.08). The sample was 42.6% White, 28.1% Other race, 4.8% Black, 4.0% Asian American, and 1.6% Native American; 57.7% identified as Hispanic. Most participants had federal insurance (66.1%) and had completed high school or higher (85.6%).

In terms of employment, 38.8% were employed full-time, 18.1% part-time, and 25.6% identified as homemakers. The majority (70.2%) were married or living with a partner. Psychosocial risk factors included financial insecurity (13.7%), food insecurity (4.2%), and high stress (14.3%). Poor family and partner support were reported by 13.4% and 2.6% of participants, respectively. A history of emotional or physical abuse and forced sexual activity were each reported by 3.4% of the sample, while 4.3% reported current emotional or psychiatric problems. Over half of participants (51.0%) had one psychosocial vulnerability, 18.1% had two, and 6.8% had three or more. The mean first-trimester EPDS total score was 3.92 (SD = 4.06), with 11.5% screening positive for depressive symptoms; the mean anxiety subscale score was 2.63 (SD = 2.65). Among the 48 unscheduled cesarean births, the most frequently reported indication was non-reassuring fetal heart tracing or fetal distress (54.2%), followed by failure to progress after 6 cm dilation (12.5%), maternal request (10.4%), failed induction prior to 6 cm (8.3%), failure to descend with pushing (8.3%), and other reasons (8.3%).

Conclusion:

None of the nine individual psychosocial variables were significantly associated with reason for admission or mode of delivery. None of the individual psychosocial or environmental predictors were significantly associated with maternal request for cesarean section once labor or induction had started. High levels of stress did show a trend towards increased likelihood of delivering with planned cesarean section and lower chance of delivering via spontaneous labor or unplanned cesarean section, consistent with published literature.