Disparities by race/ethnicity in unplanned cesarean birth among healthy nulliparas: a secondary analysis of the nuMoM2b dataset

• Type of Material: Article
• Authors: Nicole Carlson, Emory University; Madelyn S Carlson, CUNY Graduate School of Public Health & Health Policy, New York; Elise N Erickson, University of Arizona; Melinda Higgins, Emory University; Abby J Britt, Emory University; Alexis Amore, Emory University
• Language: English
• Date: 2023-05-12
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © 2023, The Author(s)
• Final Published Version (URL): http://dx.doi.org/10.1186/s12884-023-05667-6
• Title of Journal or Parent Work: BMC PREGNANCY AND CHILDBIRTH
• Volume: 23
• Issue: 1
• Start Page: 342
• End Page: 342
• Grant/Funding Information: Dr. Nicole Carlson was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number R01NR019254 during research contained in this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.; Dr. Elise Erickson was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number R00NR019596 during research contained in this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.; The nuMoM2b Study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be) was supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): U10 HD063036; U10 HD063072; U10 HD063047; U10 HD063037; U10 HD063041; U10 HD063020; U10 HD063046; U10 HD063048; and U10 HD063053. In addition, support was provided by Clinical and Translational Science Institutes: UL1TR001108 and UL1TR000153.
• Keywords: LABOR; Cesarean section; Labor; Ethnicity; ETHNIC-DIFFERENCES; DELIVERY; Pregnancy; MORTALITY; STRATEGIES; WOMEN; Obstetrics & Gynecology; Science & Technology; Life Sciences & Biomedicine; Race; Racism; SEVERE MATERNAL MORBIDITY; RACISM; INDUCTION; UNITED-STATES

Abstract

Background: Racial disparities exist in maternal morbidity and mortality, with most of these events occurring in healthy pregnant people. A known driver of these outcomes is unplanned cesarean birth. Less understood is to what extent maternal presenting race/ethnicity is associated with unplanned cesarean birth in healthy laboring people, and if there are differences by race/ethnicity in intrapartum decision-making prior to cesarean birth. Methods: This secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset involved nulliparas with no significant health complications at pregnancy onset who had a trial of labor at ≥ 37 weeks with a singleton, non-anomalous fetus in cephalic presentation (N = 5,095). Logistic regression models were used to examine associations between participant-identified presenting race/ethnicity and unplanned cesarean birth. Participant-identified presenting race/ethnicity was used to capture the influence of racism on participant’s healthcare experiences. Results: Unplanned cesarean birth occurred in 19.6% of labors. Rates were significantly higher among Black- (24.1%) and Hispanic- (24.7%) compared to white-presenting participants (17.4%). In adjusted models, white participants had 0.57 (97.5% CI [0.45–0.73], p < 0.001) lower odds of unplanned cesarean birth compared to Black-presenting participants, while Hispanic-presenting had similar odds as Black-presenting people. The primary indication for cesarean birth among Black- and Hispanic- compared to white-presenting people was non-reassuring fetal heart rate in the setting of spontaneous labor onset. Conclusions: Among healthy nulliparas with a trial of labor, white-presenting compared to Black or Hispanic-presenting race/ethnicity was associated with decreased odds of unplanned cesarean birth, even after adjustment for pertinent clinical factors. Future research and interventions should consider how healthcare providers’ perception of maternal race/ethnicity may bias care decisions, leading to increased use of surgical birth in low-risk laboring people and racial disparities in birth outcomes.