Assessing the Impact of Age, Gestation, SES, and Ethnicity on Labor Inductions

Purpose: to evaluate the likelihood of cesarean births based on race, ethnicity, socioeconomic status, maternal education and age, and gestational status for labor inductions on primiparous and multiparous women. Design and Method: A retrospective descriptive correlational design was conducted on 1325 women scheduled for induction at a large tertiary hospital in the southwest from January 1 through December 31, 2005. Birth outcomes were matched against inpatient hospital scheduling induction logs to verify indication for induction (elective or indicated). Analysis using multiple regression addressed, (1) failed inductions resulting in cesarean births, (2) mother's age, (3) ethnicity, (4) mother's education, (5) Medicaid coverage (as a proxy for SES), and (6) newborn gestational age. Findings: Age and gestation have a nonlinear and significant impact on the probability of having a cesarean birth, with elective inductions for primiparous women also significantly increasing the likelihood of cesarean delivery. The independent effect of being a primiparous woman with an elective induction increases the probability of a cesarean birth by 50% (p = .01). This did not hold for multiparous women, who were also more likely to have a cesarean birth following an induction but the effects were never statistically significant. Mother's educational level was a significant predictor for cesarean births with multiparous women being induced. Ethnicity and SES did not increase the odds of cesarean delivery following labor induction for either primiparous women or multiparous women. Conclusion: Elective labor induction for nulliparous women should only be offered with caution, particularly for women with advanced maternal age.