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

Abstract

Background Our objective was to examine the likelihood of primary cesarean delivery for women at low risk for the procedure in Massachusetts. Methods Birth certificate data for all births from 1996 to 2010 that were nulliparous, term, singleton, and vertex (NTSV; N = 427,393) were used to conduct logistic regression models to assess the likelihood of a cesarean delivery for each of the 31 ethnic groups relative to self‐identified “American” mothers. The results were compared with broad classifications of race/ethnicity more commonly employed in research. Results While 23.3 percent of American women had primary cesarean deliveries, cesarean delivery rates varied from 12.9 percent for Cambodian to 32.4 percent for Nigerian women. Women from 21 of 30 ethnic groups had higher odds of a primary cesarean (range of adjusted odds ratios [AORs] 1.09–1.77), while only Chinese, Cambodian, and Japanese women had lower odds (range of AORs 0.66–0.92), compared with self‐identified “Americans.” Using broad race/ethnicity categories, Non‐Hispanic black, Hispanic, and “Other” women had higher odds of cesarean delivery relative to Non‐Hispanic white women (range of AORs 1.12–1.47), while there were no differences for Asian or Pacific Islander women. Conclusions Detailed maternal ethnicity explains the variation in NTSV cesarean delivery rates better than broad race/ethnicity categories. Different patterns of cesarean delivery between ethnic groups suggest cultural specificity related to birth culture.

Variation in Vaginal Birth After Cesarean by Maternal Race and Detailed Ethnicity

“…Consistent with findings from our previous study on primary cesarean rates [15], Brazilian and Cambodian women had the lowest and highest VBAC rates, respectively, of all detailed ethnic groups.…”

“…Use of standard categories can misclassify and therefore inaccurately make conclusions about disparities among minorities [15]. We therefore hypothesized that significant variation would exist in VBAC rates among ethnic groups not evident when examined by standard racial/ethnic classifications; furthermore, this variability would persist after adjustment for independent variables known to be associated with VBAC rates (maternal age, parity, maternal education, marital status, place of birth, prenatal care adequacy, infant birth weight, delivery source of payment, and hospital of birth).…”

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.…”

Limitations of Vaginal Birth After Cesarean Success Prediction

“…However, unlike BMI, prior labor course, or age, race and ethnicity are social, not medical, conditions. Many scientists have reached the conclusion that race categories have little if any biological or genetic basis but operate instead as proxies for social factors associated with health and other life chances that we either do not, will not, or cannot measure …”

“…Many scientists have reached the conclusion that race categories have little if any biological or genetic basis but operate instead as proxies for social factors associated with health and other life chances that we either do not, will not, or cannot measure. [34][35][36][37][38] There is no evidence that Latina or African American women are biologically less capable of vaginal birth than white women. Fagerberg's study included women from sub-Saharan Africa, Spain, Portugal, and South America, as well as Swedish natives.…”