title: Employment during pregnancy and obstetric intervention without medical reason: labor induction and cesarean delivery.
abstract: BACKGROUND
  Rising rates of labor induction and cesarean delivery, especially when used without a medical reason, have generated concern among clinicians, women, and policymakers. Whether employment status affects pregnant women's childbirth-related care is not known. We estimated the relationship between prenatal employment and obstetric procedures, distinguishing whether women reported that the induction or cesarean was performed for medical reasons.
  
  
  METHODS
  Using data from a nationally representative sample of women who gave birth in U.S. hospitals (n = 1,573), we used propensity score matching to reduce potential bias from nonrandom selection into employment. Outcomes were cesarean delivery and labor induction, with and without a self-reported medical reason. Exposure was prenatal employment status (full-time employment, not employed). We conducted separate analyses for unmatched and matched cohorts using multivariable regression models.
  
  
  RESULTS
  There were no differences in labor induction based on employment status. In unmatched analyses, employed women had higher odds of cesarean delivery overall (adjusted odds ratio [AOR], 1.45; p = .046) and cesarean delivery without medical reason (AOR, 1.94; p = .024). Adding an interaction term between employment and college education revealed no effects on cesarean delivery without medical reason. There were no differences in cesarean delivery by employment status in the propensity score-matched analysis.
  
  
  CONCLUSIONS
  Full-time prenatal employment is associated with higher odds of cesarean delivery, but this association was not explained by socioeconomic status and no longer existed after accounting for sociodemographic differences by matching women employed full time with similar women not employed during pregnancy.
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota. Electronic address: kbk@umn.edu.
authors.forename: Katy Backes
authors.initials: KB
authors.lastname: Kozhimannil
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Attanasio
authors.affiliation: Medica Research Institute, Minnetonka, Minnesota.
authors.forename: Pamela Jo
authors.initials: PJ
authors.lastname: Johnson
authors.affiliation: Department of Family Medicine and Community Health, University of Minnesota Medical School, St. Paul, Minnesota.
authors.forename: Dwenda K
authors.initials: DK
authors.lastname: Gjerdingen
authors.affiliation: Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: McGovern
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data*; D004651:Employment / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000191:economics / Q000706:statistics & numerical data*; D016015:Logistic Models; D015999:Multivariate Analysis; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D037841:Pregnant People; D057216:Propensity Score; D012307:Risk Factors; D012959:Socioeconomic Factors; D014931:Women, Working