Table 2. Maternal experiences and attitudes toward birth, by type of payer.
| Insurer | ||||
|---|---|---|---|---|
| Medi-Cal | Commercial | |||
| Provider Choice and Experience (All women n = 2,318) | % | 95% C.I. | % | 95% C.I. |
| Had choice of provider* | 73.4 | 70.8–75.9 | 87.1 | 84.9–89.0 |
| Did not have choice* | 25.6 | 23.1–28.2 | 12.8 | 10.9–15.0 |
| Looked for cesarean rate of prospective birthing hospital* | 29.5 | 26.9–32.3 | 35.5 | 32.5–38.5 |
| Prenatal provider | ||||
| Obstetrician* | 76.1 | 73.6–78.5 | 84.4 | 82.2–86.4 |
| A doctor, not sure what kind* | 6.8 | 5.4–8.5 | 0.8 | 0.4–1.5 |
| Would have preferred a different kind of provider* | 14.5 | 12.6–16.7 | 8.9 | 7.3–10.8 |
| Of these, prefer a Midwife* | 41.4 | 34.0–49.3 | 62.8 | 52.3–72.2 |
| Birth Attendant | ||||
| Obstetrician* | 67.9 | 65.2–70.6 | 77.9 | 75.6–80.1 |
| A doctor, not sure what kind* | 19.0 | 16.7–21.4 | 6.4 | 5.0–8.0 |
| Midwife* | 6.3 | 5.2–7.7 | 12.5 | 11.1–14.1 |
| Intrapartum Experiences Vaginal births (n = 1,635) | ||||
| Attempted induction | 41.2 | 37.8–44.7 | 47.0 | 43.4–50.7 |
| Vaginal–pressure for induction | 13.2 | 10.9–15.8 | 18.5 | 15.8–21.4 |
| VBAC issues (Women with 1 or 2 prior cesareans = 423) | ||||
| Interested in VBAC | 47.4 | 40.5–54.4 | 46.4 | 36.9–56.2 |
| No option for VBAC* | 65.4 | 58.5–71.7 | 38.9 | 29.8–48.9 |
| Discussed VBAC/repeat cesarean decision | ||||
| Provider asked opinion* | 64.9 | 56.6–72.4 | 87.5 | 79.6–92.7 |
| Was woman’s decision | 26.0 | 19.5–33.8 | 42.8 | 33.4–52.8 |
| Was provider’s decision | 27.4 | 20.6–35.5 | 13.5 | 8.1–21.8 |
| Medical interventions (Vaginal births only n = 1,635) | ||||
| Episiotomy (English primary language) (n = 1,328) | 15.8 | 12.1–20.3 | 17.1 | 14.0–20.7 |
| Given choice about episiotomy (among those who experienced episiotomy, n = 141)* | 10.4 | 4.7–21.2 | 31.3 | 22.2–42.3 |
| Pain relief medications (Vaginal births n = 1,635) | ||||
| Epidural* | 61.7 | 58.2–65.1 | 74.1 | 70.7–77.1 |
| Woman felt pressured for epidural* | 13.4 | 11.1–16.1 | 8.1 | 6.3–10.2 |
| Used no pain medication | 25.3 | 22.3–28.5 | 19.7 | 17.0–22.8 |
| Woman felt pressure to have a cesarean | 13.1 | 11.2–15.3 | 9.2 | 7.6–11.2 |
| Pregnancy complication reported on birth certificate | 19.2 | 17.0–21.6 | 18.6 | 16.3–21.2 |
| Mode of birth | ||||
| Overall cesarean rate (All women n = 2,318) | 33.6 | 30.8–36.4 | 28.1 | 25.4–31.0 |
| Nulliparous term, singleton, vertex cesarean rate | 28.8 | 24.0–34.2 | 24.4 | 20.5–28.7 |
| Vaginal birth after cesarean (VBAC) rate (Women with 1 or 2 prior cesareans n = 423) | 12.6 | 9.6–16.3 | 16.4 | 12.3–21.5 |
| Experiences of staff support (% agree strongly) | ||||
| Staff encouraged maternal decision making* | 46.9 | 43.6–50.2 | 54.3 | 50.9–57.6 |
| Well supported by staff | 73.6 | 70.6–76.4 | 76.7 | 73.8–79.5 |
| Staff communicated well | 76.4 | 73.5–79.0 | 72.3 | 69.1–75.2 |
| Strongly agree birth shouldn’t be interfered with unless medically necessary (All women n = 2,318)* | 55.9 | 52.9–58.8 | 38.5 | 35.5–41.6 |
Categories with an asterisk (*) indicate variables that differ significantly by payer in bivariate analyses (p < .05).