Risk Of Primary Cesarean Delivery: Role Of Language Preference And Language-Concordant Labor Support

INTRODUCTION: Increasing rates of cesarean deliveries (CD) in the US over recent decades have been associated with social factors such as race and migration status. This study aims to assess the effects of English language proficiency and language-concordant labor support on risk of primary CD at Beth Israel Deaconess Medical Center (BIDMC). Such labor support is offered uniquely at BIDMC-associated South Cove Community Health Center (SCCHC), which has a primarily Asian immigrant population with limited English proficiency (LEP). METHODS: We conducted a retrospective cohort study using BIDMC records of nulliparous, term, singleton, vertex (NTSV) deliveries from 2011-2016 with women over 18 years old. We used modified Poisson regression models with robust error variance to assess risk ratios for CD between English-speaking, LEP SCCHC, and LEP non-SCCHC groups, adjusting for age, education, race, insurance, and delivery year. This study received BIDMC IRB approval. RESULTS: Of the 11,599 women included, 89.8% (n=10,411) were English-speaking, 5.6% (n=654) were LEP at SCCHC, and 4.6% (n=534) were LEP at a non-SCCHC practice. Proportions of CD were 24.4% (n=2,537), 17.1% (n=112), and 22.1% (n=118), respectively. LEP women at SCCHC had 0.75 (95% CI 0.61-0.93) times the risk of CD compared with English-speaking women; the risk for CD was not significantly different between non-SCCHC LEP and English-speaking women (RR 0.89, 95% CI 0.75-1.05). CONCLUSION: Prenatal care provision at SCCHC for women with LEP was associated with a 25% decreased risk of CD, suggesting that language-concordant labor support can play a key role in limiting rates of NTSV cesarean deliveries.