Racial and ethnic differences in primary, unscheduled cesarean deliveries among low-risk primiparous women at an academic medical center: a retrospective cohort study

Abstract

BackgroundCesarean sections are the most common surgical procedure for women in the United States. Of the over 4 million births a year, one in three are now delivered in this manner and the risk adjusted prevalence rates appear to vary by race and ethnicity. However, data from individual studies provides limited or contradictory information on race and ethnicity as an independent predictor of delivery mode, precluding accurate generalizations. This study sought to assess the extent to which primary, unscheduled cesarean deliveries and their indications vary by race/ethnicity in one academic medical center.MethodsA retrospective, cross-sectional cohort study was conducted of 4,483 nulliparous women with term, singleton, and vertex presentation deliveries at a major academic medical center between 2006–2011. Cases with medical conditions, risk factors, or pregnancy complications that can contribute to increased cesarean risk or contraindicate vaginal birth were excluded. Multinomial logistic regression analysis was used to evaluate differences in delivery mode and caesarean indications among racial and ethnic groups.ResultsThe overall rate of cesarean delivery in our cohort was 16.7%. Compared to White women, Black and Asian women had higher rates of cesarean delivery than spontaneous vaginal delivery, (adjusted odds ratio {AOR}: 1.43; 95% CI: 1.07, 1.91, and AOR: 1.49; 95% CI: 1.02, 2.17, respectively). Black women were also more likely, compared to White women, to undergo cesarean for fetal distress and indications diagnosed in the first stage as compared to the second stage of labor.ConclusionsRacial and ethnic differences in delivery mode and indications for cesareans exist among low-risk nulliparas at our institution. These differences may be best explained by examining the variation in clinical decisions that indicate fetal distress and failure to progress at the hospital-level.

Macrosomic and low birth weight neonates in Pacific Islanders from Samoa: a case–control study

“…Labor and delivery outcomes are influenced by individual, cultural, and ethnic factors [1]. Specifically, ethnic background has been described as an independent predictor of neonatal morbidity and mortality in a variety of populations [2,3].…”

The Influence of Detailed Maternal Ethnicity on Cesarean Delivery: Findings from the U.S. Birth Certificate in the State of Massachusetts

“…Racial and ethnic variation in cesarean deliveries has implications for health disparities in obstetric care. Previous studies suggest that nonwhite women have a disproportionately higher risk adjusted cesarean rates as compared with white women, even after taking into account socioeconomic, behavioral, medical, and institutional-level factors (7)(8)(9)(10)(13)(14)(15)19,20). However, with few exceptions, the applicability of these findings is limited by their use of broad racial/ethnic categories, which can mask considerable within-group heterogeneity.…”

The role of ethnicity on pregnancy outcomes in women with epilepsy: The need for specific research

“…Other risk factors include a history of previous cesarean section, age older than 35 years, higher parity, presence of certain chronic diseases, and ethnicity . African, Hispanic, and Asian women were found to have higher odds of cesarean delivery compared with European women, even after taking potential confounders into account. Women with a diagnosis of epilepsy seem to have a higher risk of caesarean delivery relative to control groups.…”