title: The relationship between cesarean section and labor induction.
abstract: BACKGROUND
  Numerous study results vary when analyzing the relationship between labor induction and the likelihood of cesarean delivery; and few have accounted for the multiple influences of maternal sociodemographic characteristics combined with the provider and hospital in subsequent birth outcomes such as cesarean section.
  
  
  OBJECTIVE
  This study evaluated the likelihood of cesarean birth following labor induction while accounting for maternal, hospital, and provider characteristics.
  
  
  METHODS
  A cross-sectional retrospective descriptive design using secondary data was employed to determine what variation in cesarean births was due to differences of hospitals, providers, and patients using the Quality Health Outcomes Model (QHOM). Data were partitioned by primiparous and multiparous women. The individual demographic, system, and provider outcomes in all hospitals and single birth center for Maricopa County in 2005 (N=62,816) were analyzed, using both random effects and fixed effects models.
  
  
  RESULTS
  For primiparous women, an increased likelihood of cesarean births was associated with medical inductions, maternal age, being Black, and the number of prenatal visits; and less likely in teaching hospitals and women with higher educational attainment. In multiparous women, cesarean births were associated with increased maternal age and medical inductions; and less likely in for-profit hospitals and following elective induction.
  
  
  CONCLUSIONS
  Labor inductions were associated with an increased likelihood of cesarean sections based on parity, age, race, number of prenatal visits, education, and hospital teaching status and ownership. Because the QHOM emphasizes multiple contextual variables that influence the delivery and outcomes of care, it can prove ideal for the study of birth outcomes following interventions such as the induction of labor.
  
  
  CONCLUSIONS
  Nurses should be well educated about the risks of elective labor induction prior to term gestation and "elective" cesarean birth.
authors.affiliation: Arizona State University, College of Nursing and Health Innovation, 500 North 3rd Street, Phoenix, AZ 85004, USA. barbara.l.wilson@asu.edu
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Wilson
authors.forename: Judith
authors.initials: J
authors.lastname: Effken
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Butler
mesh_terms: D000328:Adult; D001130:Arizona; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004522:Educational Status; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006777:Hospitals, Proprietary; D006784:Hospitals, Teaching; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D008423:Maternal Age; D008962:Models, Theoretical; D010043:Outcome and Process Assessment, Health Care; D010298:Parity; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors