(662) Patient Race and Experience of Control over Labor

Objective: Patients’ birth experience vary by factors including sense of control, mode of delivery, and perceived racism. We aimed to assess the role of race/racism by evaluating perceived control over labor in patients of color as compared to white patients. Our hypothesis was that patients of color would have lower perceived control than white patients.

Study Design: This secondary analysis of a cross-sectional survey study included term patients admitted for delivery at a tertiary medical center. After delivery, patients completed the Labour Agentry Scale (LAS), a validated tool to assess patients’ feelings of control over their labor and birth. Demographic, perinatal outcomes, and LAS scores were compared between patients who identified as white and those who identified as a person of color. While the lived experience of racism differs among different racial and ethnic groups, in this study, those identifying as Black, Latinx, American Indian, Asian/Pacific Islander or mixed race were analyzed as people of color (POC). Multivariable linear regressions for LAS score by race was performed accounting for known confounders and demographic differences.

Results: Of 148 patients in the parent study who self-reported race, 41 (27.7%) identified as POC (consistent with the racial makeup of our patients). POC were younger than white participants (median age 25.9 vs. 29.4 years, p< 0.001) and more likely to have public insurance (58.5% vs. 19.6%, p < 0.0001) but were otherwise similar in demographic and obstetric factors (Table 1) LAS scores were significantly higher among POC than those who identified as white (median 168 vs. 157 respectively, p=0.03), even after controlling for cesarean delivery, length of labor, public insurance, and maternal age (Table 2).

Conclusion: Contrary to our hypothesis, people of color had higher levels of perceived control over their delivery than those who identified as white. More qualitative research is planned among people of color to better examine the potential interplay between race and racism during delivery hospitalization and labor/birth agentry.