Abstract
Background: Giving birth by surgical operation (cesarean birth) is linked to complications such as postpartum infection, rehospitalization, and respiratory issues in newborns. However, the cesarean rate remains high, accounting for 32.4% of all births in the United States (U.S.). Understanding the impact of factors beyond the individual level is crucial for developing interventions to reduce preventable cesarean births and promote health equity.
Purpose/Aim: This systematic review synthesized evidence from U.S.-based studies to identify factors beyond the maternal level that are associated with mode of birth (vaginal or cesarean).
Methods: We searched PubMed, Web of Science, PsycINFO, and CINAHL for studies published from 2015 to 2025. The methodological quality of the studies was assessed using the Joanna Briggs Institute checklist and the Prediction Model Risk of Bias Assessment Tool. Narrative synthesis was conducted due to heterogeneity in study designs and measures.
Findings: Studies (N= 24) with sample sizes ranging from 45 to greater than 3.5 million births were included. Low socioeconomic status, neighborhood deprivation, occupational stressors, psychosocial stressors (e.g., acculturative stress, discrimination), and maternal clinical conditions, including obesity, diabetes, hypertension, advanced maternal age, and prior cesarean birth, were reported to be linked with higher cesarean risk. Conversely, attendance at childbirth education, individualized birth plans, and flexible work schedules were reported to increase the likelihood of vaginal birth.
Implications for Nursing and Healthy Work Environments: Reducing unnecessary cesarean births will require addressing both clinical and contextual factors. Nurses and midwives can integrate psychosocial screening, deliver culturally responsive education, and support shared decision-making. Nursing leadership can advance equity through workplace advocacy and person-centered, biopsychosocial care.
Conclusion: Mode of birth is shaped by both an individual's clinical and contextual factors. Nursing practice, leadership, and policy advocacy must incorporate multilevel strategies to reduce preventable cesarean births and promote equitable, healthy work and birth environments
Notes
References:
Afshar, Y., Wang, E. T., Mei, J., Esakoff, T. F., Pisarska, M. D., & Gregory, K. D. (2017). Childbirth education class and birth plans are associated with a vaginal delivery. Birth: Issues in Perinatal Care, 44(1), 29–34. https://doi.org/10.1111/birt.12263
Declercq, E., MacDorman, M., Osterman, M., Belanoff, C., & Iverson, R. (2015). Prepregnancy obesity and primary cesareans among otherwise low-risk mothers in 38 U.S. states in 2012. Birth, 42(4), 309–318. https://doi.org/10.1111/birt.12201
Hamilton, B. E., Martin, J. A., & Osterman, M. J. K. (2024). Vital statistics rapid release (No. 35). U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
Meeker, J. R., Burris, H. H., Bai, R., Levine, L. D., & Boland, M. R. (2022). Neighborhood deprivation increases the risk of post-induction cesarean delivery. Journal of the American Medical Informatics Association, 29(3), 329–334. https://doi.org/10.1093/jamia/ocab258
Mokashi, M., Yee, L., & Feinglass, J. (2024). Trends in severe maternal morbidity, obstetric comorbidities, and birth complications in Illinois. OG Open, 1(1), 046. https://doi.org/10.1097/og9.0000000000000046
Nicholas, S., Orzechowski, K., Berghella, V., & Baxter, J. (2015). Second trimester cervical length and its association with vaginal birth after cesarean delivery. American Journal of Perinatology, 33(1), 20–23. https://doi.org/10.1055/s-0035-1554796
Spurlock, E. J., Pickler, R. H., Ruiz, R. J., Ford, J., Gillespie, S., & Kue, J. (2023). Acculturation, acculturative stress, experience of discrimination, and cesarean birth in Mexican American women. Hispanic Health Care International: The Official Journal of the National Association of Hispanic Nurses, 21(4), 184–194. https://doi.org/10.1177/15404153231164369
Yeganegi, M., Bahrami, R., Azizi, S., Marzbanrad, Z., Hajizadeh, N., Mirjalili, S. R., Saeida-Ardekani, M., Lookzadeh, M. H., Alijanpour, K., Aghasipour, M., Golshan-Tafti, M., Noorishadkam, M., & Neamatzadeh, H. (2024). Caesarean section and respiratory system disorders in newborns. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 23, 100336. https://doi.org/10.1016/j.eurox.2024.100336
Sigma Membership
Beta Tau
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Systematic Review
Research Approach
Mixed/Multi Method Research
Keywords:
Health Equity, Social Determinants of Health, Public Health, Community Health, Stress/Coping, Psychological Stress, Stress Management
Recommended Citation
Mutaru, Abdul-Manaf; Lebron, Cynthia Nicole; Yoo, Wonsuk; Parra, Alexa; Duthely, Lunthita; O'Shea, Thomas Mike; and Santos, Hudson P. Jr., "Systematic Review of Multi-Level Determinants and Equity Implications of Mode of Birth in the U.S." (2026). Creating Healthy Work Environments (CHWE). 23.
https://www.sigmarepository.org/chwe/2026/presentations_2026/23
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-04-24
Systematic Review of Multi-Level Determinants and Equity Implications of Mode of Birth in the U.S.
Washington, DC, USA
Background: Giving birth by surgical operation (cesarean birth) is linked to complications such as postpartum infection, rehospitalization, and respiratory issues in newborns. However, the cesarean rate remains high, accounting for 32.4% of all births in the United States (U.S.). Understanding the impact of factors beyond the individual level is crucial for developing interventions to reduce preventable cesarean births and promote health equity.
Purpose/Aim: This systematic review synthesized evidence from U.S.-based studies to identify factors beyond the maternal level that are associated with mode of birth (vaginal or cesarean).
Methods: We searched PubMed, Web of Science, PsycINFO, and CINAHL for studies published from 2015 to 2025. The methodological quality of the studies was assessed using the Joanna Briggs Institute checklist and the Prediction Model Risk of Bias Assessment Tool. Narrative synthesis was conducted due to heterogeneity in study designs and measures.
Findings: Studies (N= 24) with sample sizes ranging from 45 to greater than 3.5 million births were included. Low socioeconomic status, neighborhood deprivation, occupational stressors, psychosocial stressors (e.g., acculturative stress, discrimination), and maternal clinical conditions, including obesity, diabetes, hypertension, advanced maternal age, and prior cesarean birth, were reported to be linked with higher cesarean risk. Conversely, attendance at childbirth education, individualized birth plans, and flexible work schedules were reported to increase the likelihood of vaginal birth.
Implications for Nursing and Healthy Work Environments: Reducing unnecessary cesarean births will require addressing both clinical and contextual factors. Nurses and midwives can integrate psychosocial screening, deliver culturally responsive education, and support shared decision-making. Nursing leadership can advance equity through workplace advocacy and person-centered, biopsychosocial care.
Conclusion: Mode of birth is shaped by both an individual's clinical and contextual factors. Nursing practice, leadership, and policy advocacy must incorporate multilevel strategies to reduce preventable cesarean births and promote equitable, healthy work and birth environments
Description
This presentation examines how factors beyond maternal clinical conditions influence mode of birth in the U.S. It will highlight nursing strategies to reduce disparities, strengthen equity in maternal care, and advance evidence-based practices through clinical innovation, and policy advocacy.