Group-Based Trajectory Analysis to Describe the First Stage of Labor

Abnormal progress in the first stage of labor is the most prevalent potentially modifiable indication for cesarean births. Our insights from pilot work involving 8800 women giving birth in Western Pennsylvania suggest that the current paradigm of a single course of normal labor progress is inadequate and that a precision health approach considering an individual woman's likely normal course of labor could reduce the number of cesareans performed in low-risk women with particular efficacy in minority women. We will analyze the labor trajectories of the more than 200 000 racially and ethnically diverse women included in the Consortium on Safe Labor (CSL) Database using the statistical technique of group-based trajectory analysis. CSL data were extracted from electronic health records and databases from 12 US hospitals from 7/1/02 to 7/1/08. The study sample comprises 208 695 women. Age distribution is 1 person aged 6-11 years; 12 548 aged 12-18 years; 26 206 aged 19-21 years and 169 625 aged 22 and older. The majority are of non-Hispanic ethnicity (150 111) but a substantial proportion are of Hispanic (36 460) or unknown ethnicity. The majority are white (103 138) but substantial proportions are of other races: Black or African American (46 973) Asian (8 601) Multi-Race (336) and unknown (49 647). We will identify and describe trajectories of first stage of labor progress for subsets of low risk women with both spontaneous and induced labors along with maternal fetal and labor management characteristics associated with each trajectory. We will then determine the impact use of the new trajectories would have on proportion of women whose trajectory falls outside definitions of normal yet who achieve vaginal birth. This project addresses Title V MCH Services Block Grant National Performance Domain 2 (reduce low risk cesareans) and Healthy People 2020 Objective MICH 7.1 (reduce low risk cesareans.) The project addresses MCHB Strategic Research Issue IV promoting healthy development of MCH populations because preventing cesareans decreases their long and short-term health risks for women and their current and future newborns. The project addresses MCHB Strategic Research Issue II to eliminate health disparities because black women are over-burdened by low risk cesareans