Postpartum anemia and hematologic recovery in pre-term gestation deliveries

Abstract

Continuous external fetal monitoring showing category II fetal heart tracing is a frequent indication for Cesarean birth (CB) in the United States. Black patients have higher CB rates, as well as higher rates for this indication. We sought to examine if implicit racial bias is present in providers' decisions about CB in such circumstances. STUDY DESIGN: We distributed an online survey study consisting of 2 clinical scenarios of patients in labor with category II tracings to OB-GYN providers. Patient race was randomized to Black and White; vignettes were otherwise identical. Participants had the option to continue with labor or proceed with CB at 3 points in each scenario. Participants reported their own demographics anonymously. This survey was distributed via email, listserv, and social media. RESULTS: 726 providers completed the survey. Participants overall did not demonstrate significant racial bias in CB decision-making in either scenario. However, in subgroup analysis of a scenario of a patient with prior CB, Fisher's exact test showed providers < 40 years old (n¼322, p< .05) and those with < 10 years of experience (n¼239, p< .05) opted for CB in Black women more frequently than for White women at the first decision point. As labor progressed in this scenario, rates of CB equalized across patient race. CONCLUSION: Younger providers and those with fewer years experience demonstrated racial bias in CB decision-making at the first decision point early in labor. Providers did not show racial bias as labor progressed, nor in the scenario without prior CB. This bias may result from provider training with the Maternal Fetal Medicine Unit Network's VBAC calculator, developed in 2007 and widely used to estimate the probability of successful VBAC. This calculator used race as a predictive factor until it was removed in June 2021. Future studies should investigate whether this bias persists, while also focusing on interventions to address these findings.