Online Program

Are racial disparities in cesarean rates partially explained by access to hospitals offering trial of labor after a cesarean?

Tuesday, November 5, 2013

Mary Barger, PhD, MPH, CNM, School of Nursing, University of San Diego, San Diego, CA
Elena Gates, MD, University of California San Francisco, San Francisco, CA
Jennifer Dunn, JD, Univeristy of California, Hastings, San Francisco, CA
Background: Both the total cesarean and the primary cesarean rate vary by race/ethnicity with black non-Hispanics having the highest rate (36.8% versus Hispanic women, 32.5% in California). Methods: Between November 2011 and June 2012, charge nurses at all civilian California birth hospitals were surveyed if hospitals offered or did not offer trial of labor after cesarean (TOLAC) and an array of hospital policies and provider requirements were explored. Hospital survey data were linked with hospital characteristics from the California Office of Statewide Health Planning and Development (OSHPD). For this analysis, the racial/ethnic population served by each hospital was calculated using the 2010 Inpatient Discharge file of all women discharged with a childbirth code and percent English speaking reported for all discharges. T-test was used to calculate differences by race/ethnicity of TOLAC and non-TOLAC hospitals. Results: All 243 birth hospitals contacted participated. In 2012, 139 hospitals (57.2%) offered TOLAC. There were no statistical differences by TOL hospital status for the percent of white non-Hispanics, Hispanic, Native American, or other races served. A greater percent of black non-Hispanic and Asian women delivered in TOLAC hospitals. For black non-Hispanic women the difference was 2.53% (95% CI 0.74-4.33) and for Asian women the difference was 6.75% (95% CI 3.75, 9.57). Public Health Implications: The geographic distribution of TOLAC or non-TOLAC hospitals in California does not appear to be a contributing factor in the observed racial/ethnic disparities in the state. Other causes need to be investigated to understand these disparities.

Learning Areas:

Diversity and culture
Provision of health care to the public

Learning Objectives:
Discuss the contribution of the geographic location of hospitals offering and not offering trial of labor after cesarean to the observed racial/ethnic differences in cesarean rates in California.

Keyword(s): Maternal Morbidity, Access to Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have authored four research studies dealing with issues concerning morbidity associated with cesareans and was a member of the expert panel setting the agenda for the NIH Consensus Panel on Vaginal Birth After Cesarean.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.