Journal Article

Fulfillment of Permanent Contraception among Patients with Cesarean Delivery in a Multi-Site Cohort

Berg, Kristen A, Bullington, Brooke W, Arora, Kavita Shah, Bailit, Jennifer L, Serna, Tania, Miller, Emily S, Boozer, Margaret

2024

Overview

ObjectivesThis study aimed to assess the association between insurance type and permanent contraception fulfillment among those with cesarean deliveries. Additionally, we sought to examine modification by the scheduled status of the cesarean.Study DesignWe used data from a multi-site cohort study of patients who delivered in 2018–2019 at Northwestern Memorial Hospital in Illinois, MetroHealth Medical System in Ohio, or University of Alabama at Birmingham in Alabama. All patients had permanent contraception as their contraceptive plan in their medical chart during delivery hospitalization. We used logistic regression to model the association between insurance type, scheduled status of cesarean and permanent contraception fulfillment by hospital discharge. The scheduled status of cesarean delivery was examined as an effect modifier.ResultsCompared to patients with private insurance, those with Medicaid were less likely to have their desired permanent contraception procedure fulfilled by hospital discharge (89.3% vs. 96.8%, p < 0.001). After adjusting for covariates, patients with Medicaid had a lower odds of permanent contraception fulfillment by hospital discharge (OR: 0.41; 95% CI: 0.21, 0.77). This association was stronger among those who had unscheduled cesarean deliveries (OR: 0.29; 95% CI: 0.12, 0.74) than those with scheduled cesarean deliveries (OR: 0.77; 95% CI: 0.32, 1.88).Conclusions for PracticeCompared to patients with private insurance undergoing a cesarean delivery, those with Medicaid insurance were less likely to have their desired permanent contraception fulfilled. Physicians and hospitals must examine their practices surrounding Medicaid forms to ensure that patients have valid consent forms available at the time of delivery.SignificanceWhat is already known about this subject?Studies have shown that the Medicaid sterilization consent process is associated with decreased fulfillment of desired postpartum permanent contraception. Cesarean delivery is one of the strongest predictors of permanent contraception fulfillment.What this study adds?This study found that Medicaid is associated with decreased permanent contraception fulfillment in a subset of patients who had cesarean deliveries in a national multi-center cohort. These associations were particularly strong among patients who had unscheduled, compared to scheduled, cesarean deliveries.

• Publisher: Springer Nature B.V
• Subject: Birth control / Cesarean section / Government programs / Medicaid