The relationship of maternal and maternity care provider characteristics to the diagnosis of labor dystocia.
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Cunningham, Emilie Marie, 1973-
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Background: To decrease the overall cesarean rate, recent efforts have focused on reducing non-emergent and otherwise low-risk cesarean births. Labor dystocia, the slowing or cessation of labor progression, is the leading indication for a primary cesarean birth. Although nonclinical factors have been linked to the incidence of labor dystocia, less is known about the relationship of those factors with the observed characteristics of the dystocia diagnosis. The purpose of this study was to determine whether 1) provider gender or years of practice and 2) maternal personal characteristics are associated with specific attributes of a labor dystocia diagnosis. Methods: This retrospective case series included all singleton, cephalic births ending in an unplanned primary cesarean exclusively due to labor dystocia between May 2014 and December 2017 at a for-profit, urban Texas health facility (n=291). Variables of interest were duration of labor and cervical dilation at the time of dystocia diagnosis. Mean values were compared among individual providers, provider gender, and years of practice, as well as maternal race/ethnicity, education, marital status, insurance status, age and pre-pregnancy body mass index to determine any relationships of significance. Logistic regression was used to determine the likelihood of diagnosis occurring before 6 centimeters cervical dilation, and Cox proportional hazard models were applied to determine risk of earlier diagnosis among comparative maternal and provider characteristics. Results: After adjusting for cervical ripening and epidural use in a multiple regression analysis, provider years of practice remained significantly associated (p=0.0003) with duration of first stage labor. Maternal obesity was associated with a reduced first stage cervical dilation and second stage duration. Government insurance status was consistently associated with a less advanced cervical dilation at the time of diagnosis (p=0.0003). A majority of subjects (59%) received a dystocia diagnosis before 6 centimeters of cervical dilation. Conclusions: There were significant relationships between provider years of practice and labor duration before a dystocia diagnosis. Economically disadvantaged and obese women experienced a diagnosis at a less advanced cervical dilation. Providers should be informed of who is at risk of earlier labor dystocia diagnoses and encouraged to adhere to the recommended diagnosis threshold of six centimeters.