Interpersonal processes of care and cesarean delivery in two health care settings

Objectives. We examined whether interpersonal processes of care (IPC) were associated with cesarean delivery. Methods. We performed a cross-sectional study of 1308 postpartum women at Kaiser Permanente Medical Center in Walnut Creek, CA (KP-WC), and San Francisco General Hospital (SFGH) from 2004 to 2006. Using interview and medical record data, logistic regression analyses estimated the odds of cesarean delivery as a function of IPC domains. Results. After adjustment for demographic and reproductive factors, women at KP-WC who reported higher scores for their provider's "elicitation of patient concerns and responsiveness" were less likely to have delivered by cesarean, whereas women who reported higher scores for "empowerment and self-care" were more likely. At KP-WC, women who reported low English proficiency were less likely to have delivered by cesarean than women who reported high proficiency. At SFGH, none of the IPC measures were significant; however, younger age was associated with a lower risk of cesarean delivery, whereas higher educational attainment was associated with an increased risk. Conclusions. To reduce record-high rates of cesarean delivery, more emphasis should be placed on addressing the nonmedical factors associated with operative delivery.