title: Patient-Perceived Pressure from Clinicians for Labor Induction and Cesarean Delivery: A Population-Based Survey of U.S. Women.
abstract: OBJECTIVE
  To determine whether patient-perceived pressure from clinicians for labor induction or cesarean delivery is significantly associated with having these procedures.
  
  
  METHODS
  Listening to Mothers III, a nationally representative survey of women 18-45 years who delivered a singleton infant in a U.S. hospital July 2011-June 2012 (N = 2,400).
  
  
  METHODS
  Multivariate logistic regression analysis of factors associated with perceived pressure and estimation of odds of induction and cesarean given perceived pressure.
  
  
  RESULTS
  Overall, 14.8 percent of respondents perceived pressure from a clinician for labor induction and 13.3 percent for cesarean delivery. Women who perceived pressure for labor induction had higher odds of induction overall (adjusted odds ratio [aOR]: 3.51; 95 percent confidence interval [CI]: 2.5-5.0) and without medical reason (aOR: 2.13; 95 percent CI: 1.3-3.4) compared with women who did not perceive pressure. Those perceiving pressure for cesarean delivery had higher odds of cesarean overall (aOR: 5.17; 95 percent CI: 3.2-8.4), without medical reason (aOR: 6.13; 95 percent CI: 3.4-11.1), and unplanned cesarean (aOR: 6.70; 95 percent CI: 4.0-11.3).
  
  
  CONCLUSIONS
  Patient-perceived pressure from clinicians significantly predicts labor induction and cesarean delivery. Efforts to reduce provider-patient miscommunication and minimize potentially unnecessary procedures may be warranted.
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN.
authors.forename: Judy
authors.initials: J
authors.lastname: Jou
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN.
authors.forename: Katy B
authors.initials: KB
authors.lastname: Kozhimannil
authors.affiliation: Center for Spirituality & Healing and the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
authors.forename: Pamela Jo
authors.initials: PJ
authors.lastname: Johnson
authors.affiliation: National Partnership for Women and Families, Washington, DC.
authors.forename: Carol
authors.initials: C
authors.lastname: Sakala
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002585:Cesarean Section / Q000523:psychology*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000523:psychology*; D008875:Middle Aged; D010358:Patient Participation; D011247:Pregnancy; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
keywords: Cesarean delivery; labor induction; provider-patient communication; shared decision making