Racial and Ethnic Differences in Indication for Primary Cesarean Delivery at Term: Experience at One U.S. Institution

Authors


  • Funding for this publication was supported by grants from the National Institutes of Health (NIH/NCRR/OD UCSF-CTSI Grant No. KL2 RR024130), Washington, DC, and from the Amos Medical Faculty Development Award of the Robert Wood Johnson Foundation (Grant No. RWJF-63524), Princeton, New Jersey, United States of America, to Dr Allison Bryant. Dr Aaron Caughey is supported by the Robert Wood Johnson Foundation as a Physician Faculty Scholar (Grant No. RWJF-61535), Princeton, New Jersey, United States of America.

Address correspondence to Dr. Allison S. Bryant, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Founders 4, Boston, MA 02114, USA.

Abstract

Background

Black and Latina women in the United States are known to undergo cesarean delivery at a higher rate than other women. We sought to explore the role of medical indications for cesarean delivery as a potential explanation for these differences.

Methods

A retrospective cohort study was conducted of 11,034 primiparas delivering at term at the University of California, San Francisco, between 1990 and 2008. We used multivariable analyses to evaluate racial and ethnic differences in risks of, and indications for, cesarean delivery.

Results

The overall rate of cesarean delivery in our cohort was 21.9 percent. Black and Latina women were at significantly higher odds of undergoing cesarean delivery than white women (adjusted odds ratio or AOR: 1.54; 95% CI: 1.30, 1.83, and 1.21; 95% CI: 1.03, 1.43, respectively). Black women were at significantly higher odds of undergoing cesarean delivery for nonreassuring fetal heart tracings than white women (AOR: 2.19; 95% CI: 1.55, 3.09), and black women (AOR: 1.55; 95% CI: 1.21, 1.98), Latina women (AOR: 1.48; 95% CI: 1.19, 1.85), and Asian women (AOR: 1.47; 95% CI: 1.22, 1.85) were at significantly higher odds of undergoing cesarean delivery for failure to progress. Black, Latina, and Asian women were at significantly lower odds of undergoing cesarean delivery for malpresentation than white women (AOR: 0.56; 95% CI: 0.34, 0.89, 0.66; 95% CI: 0.44, 0.98, and 0.55; 95% CI: 0.40, 0.76, respectively).

Conclusions

Racial and ethnic differences exist in specific indications for cesarean delivery among primiparas. Clarifying the possible reasons for increased cesareans for nonreassuring fetal heart tracing in black women, in particular, may help to decrease excess cesarean deliveries in this racial and ethnic group. (BIRTH 39:2 June 2012)

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