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Open Access Research article

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

Joyce K Edmonds1*, Revital Yehezkel2, Xun Liao2 and Tiffany A Moore Simas2

Author Affiliations

1 William F. Connell School of Nursing, Boston College, 140 Commonwealth Ave, 02467, Chestnut Hill, MA, USA

2 Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Medical Center, 119 Belmont Street, 01605, Worcester, MA, USA

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BMC Pregnancy and Childbirth 2013, 13:168  doi:10.1186/1471-2393-13-168

Published: 3 September 2013

Abstract

Background

Cesarean 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.

Methods

A 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.

Results

The 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.

Conclusions

Racial 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.

Keywords:
Cesarean delivery; Race and ethnicity; Mode of delivery; Nulliparous; Healthcare disparity