Online Program

Racial and ethnic differences in primary, unscheduled cesarean deliveries among low-risk primiparous women at an academic medicalcenter: A descriptive, retrospective cohort study

Wednesday, November 6, 2013

Joyce Edmonds, PhD, MPH, RN, APHN-BC, CPH, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
Background: Cesarean sections are the most common surgical procedure for women in the US. Of the over 4 million births a year, one-third are Cesarean sections. We assessed the extent to which primary, unscheduled cesarean deliveries and their indications vary by race/ethnicity in a major 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.

Learning Areas:

Clinical medicine applied in public health
Provision of health care to the public
Public health or related nursing

Learning Objectives:
Assess the variance in primary, unschedule cesarean deliveries and their indications by race/ethnicity

Keyword(s): Pregnancy, Women's Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the PI for this study, analyzed the data, and prepared the results and discussion.
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.