Title: 1032: Can we identify risk factors for decreased birth satisfaction among women undergoing induction of labor?
Abstract: Induction of labor (IOL) is one of the most common obstetrical procedures. Prior studies have demonstrated decreased birth satisfaction associated with IOL. Patient satisfaction with the labor process has been directly linked to healthy mother/baby bonding, improved breastfeeding rates, and a decreased risk for postpartum depression. We sought to determine what factors impact birth satisfaction in women undergoing IOL with the ultimate goal of targeting women at highest risk for decreased satisfaction. We performed a prospective cohort study of women with term (≥37 weeks) singleton gestations undergoing IOL with an unfavorable cervix at our institution from Jan 2018 to June 2018. Women completed a modified version of the validated 10 question Birth Satisfaction Scale-Revised (BSS-R) postpartum. Women with a BSS- R score above the mean were classified as "satisfied" and women with a BSS-R below the mean were classified as "unsatisfied." Risk factors for satisfaction were evaluated by univariate analysis that included Chi-square for categorical and Wilcoxon rank sum for continuous variables. Multivariable analysis was performed using logistic regression. 330 of 414 (79.7%) of eligible patients completed the BSS-R and were included in the analysis. There was no significant difference in birth satisfaction by maternal age, BMI, starting Bishop score, or induction agent. Self- identified Black women were more likely to be unsatisfied than White women (54.0% vs. 37.2%, p=0.037), nulliparas were more likely to be unsatisfied compared to multiparas (54.2% vs. 40.9%, p=0.019), and women whose labor resulted in a cesarean delivery were more likely to be unsatisfied than women with a vaginal delivery (67.4 vs. 42.3%, p<0.001). Additionally, increased labor length quartile was associated with decreased satisfaction (p=0.003). This trend held true even for women that had a vaginal delivery (Figure). In multivariable analysis, race, mode of delivery and labor length quartile remained independent risk factors for decreased satisfaction. Black race, nulliparity, cesarean delivery, and increasing labor length were identified as risk factors for decreased birth satisfaction among induced women. Safe methods to reduce labor length in IOL should be explored as a means to improve birth satisfaction.