The Association between Maternal Race and Ethnicity and Risk Factors for Primary Cesarean Delivery in Nulliparous Women

Abstract

Objective To understand whether maternal, perinatal, and systems-level factors can be identified to explain racial/ethnic disparities in cesarean delivery rates. Study Design This retrospective cohort study included nulliparous women with singleton gestations who delivered at a tertiary care center from 2015 to 2017. Maternal, perinatal, and systems-level factors were compared by race/ethnicity. Multilevel multivariable logistic regression was used to identify whether race/ethnicity was independently associated with cesarean. Effect modification was evaluated using interaction terms. Bivariable analyses and multinomial logistic regression were used to determine differences in indication for cesarean. Results Of 9,865 eligible women, 2,126 (21.5%) delivered via cesarean. The frequency of cesarean was lowest in non-Hispanic white women (19.2%) and highest in non-Hispanic black women (28.2%; p < 0.001). Accounting for factors associated with cesarean delivery did not lessen the odds of cesarean associated with non-Hispanic black race (aOR: 1.58, 95% CI: 1.31–1.91). Compared with non-Hispanic white women, non-Hispanic black women were more likely to undergo cesarean for nonreassuring fetal status (aOR: 2.73, 95% CI: 2.06–3.61). Conclusion Examined maternal, perinatal, and systems-level risk factors for cesarean delivery did not explain the racial/ethnic disparities observed in cesarean delivery rates. Increased cesarean delivery for nonreassuring fetal status contributed substantially to this disparity.

The Role of Oxytocin in Primary Cesarean Birth Among Low‐Risk Women

“…Black women with an NTSV pregnancy in this sample had an increased odds of having a cesarean compared with white women, even when adjusting for the other variables in the model. This increased odds of cesarean birth among Black women has been reported in many other studies that have controlled for maternal, perinatal, and system risk factors 6,36‐38 . Black women are also more likely to receive a cesarean for having Category II/III fetal heart rate patterns, whereas white women are more likely to have a cesarean for failure to progress 6,37 …”

“…This increased odds of cesarean birth among Black women has been reported in many other studies that have controlled for maternal, perinatal, and system risk factors. 6,[36][37][38] Black women are also more likely to receive a cesarean for having Category II/III fetal heart rate patterns, whereas white women are more likely to have a cesarean for failure to progress. 6,37 One clinical implication of the finding that higher doses of oxytocin are associated with a higher odds of cesarean might be to find ways to decrease oxytocin total dose exposure by discontinuing oxytocin for women in active labor.…”

“…6,[36][37][38] Black women are also more likely to receive a cesarean for having Category II/III fetal heart rate patterns, whereas white women are more likely to have a cesarean for failure to progress. 6,37 One clinical implication of the finding that higher doses of oxytocin are associated with a higher odds of cesarean might be to find ways to decrease oxytocin total dose exposure by discontinuing oxytocin for women in active labor. 39,40 A Cochrane review of discontinuing oxytocin in the active phase of labor found that stopping oxytocin in active labor (defined as well-established contractions and >5 cm dilatation) was associated with a decreased cesarean birth rate (relative risk, 0.69; 95% CI, 0.56-0.86), although this was low-certainty evidence.…”

Development And Validation Of Models To Predict Cesarean Delivery Among Low-Risk Nulliparous Women At Term: A Retrospective Study In China

“…Past studies also found gestational age of induced labor and induction methods were related to the incidence of cesarean [24,25]. The ethnic disparity was observed in cesarean delivery rates, Stark et al showed that the frequency of cesarean was lowest in non-Hispanic white women and highest in non-Hispanic black women [26]. In addition, delivery time, clinicians' personal beliefs and pregnant women themselves' views of decision-making also have an impact on delivery mode [27][28][29].…”

Development and validation of models to predict cesarean delivery among low-risk nulliparous women at term: a retrospective study in China

“…Past studies also found gestational age of induced labor and induction methods were related to the incidence of cesarean [27,28]. The ethnic disparity was observed in cesarean delivery rates, Stark et al showed that the frequency of cesarean was lowest in non-Hispanic white women and highest in non-Hispanic black women [29]. In addition, delivery time, clinicians' personal beliefs and pregnant women themselves' views of decision-making also have an impact on delivery mode [30][31][32].…”