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.

  Findings: 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. Copyright (C) 2014 by the

  Jacobs Institute of Women''s Health. Published by Elsevier Inc.'
affiliation: 'Kozhimannil, KB (Corresponding Author), Univ Minnesota, Sch Publ Hlth,
  Div Hlth Policy \& Management, 420 Delaware St SE,MMC 729, Minneapolis, MN 55455
  USA.

  Kozhimannil, Katy Backes; Attanasio, Laura B., Univ Minnesota, Sch Publ Hlth, Div
  Hlth Policy \& Management, Minneapolis, MN 55455 USA.

  Johnson, Pamela Jo, Med Res Inst, Minnetonka, MN USA.

  Gjerdingen, Dwenda K., Univ Minnesota, Sch Med, Dept Family Med \& Community Hlth,
  St Paul, MN 55108 USA.

  McGovern, Patricia M., Univ Minnesota, Sch Publ Hlth, Div Environm Hlth Sci, Minneapolis,
  MN USA.'
author: Kozhimannil, Katy Backes and Attanasio, Laura B. and Johnson, Pamela Jo and
  Gjerdingen, Dwenda K. and McGovern, Patricia M.
author-email: kbk@umn.edu
author_list:
- family: Kozhimannil
  given: Katy Backes
- family: Attanasio
  given: Laura B.
- family: Johnson
  given: Pamela Jo
- family: Gjerdingen
  given: Dwenda K.
- family: McGovern
  given: Patricia M.
da: '2023-09-28'
doi: 10.1016/j.whi.2014.06.010
eissn: 1878-4321
files: []
issn: 1049-3867
journal: WOMENS HEALTH ISSUES
keywords-plus: 'MATERNITY LEAVE; BIRTH OUTCOMES; SOCIOECONOMIC DISPARITIES;

  AMERICAN-COLLEGE; UNITED-STATES; CHILD-HEALTH; HIGH-QUALITY; SCORE;

  WORK; RISK'
language: English
month: SEP-OCT
number: '5'
number-of-cited-references: '58'
orcid-numbers: Johnson, Pamela Jo/0000-0003-3034-1378
pages: 469-476
papis_id: 023e7e2d746475e897aa66e698bddff9
ref: Kozhimannil2014employmentpregnancy
times-cited: '1'
title: 'Employment During Pregnancy and Obstetric Intervention Without Medical Reason:
  Labor Induction and Cesarean Delivery'
type: Article
unique-id: WOS:000345157500002
usage-count-last-180-days: '1'
usage-count-since-2013: '4'
volume: '24'
web-of-science-categories: Public, Environmental \& Occupational Health; Women's Studies
year: '2014'