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William F. Connell School of Nursing

Race and ethnicity matter in C-section decisions

by corinne steinbrenner

At a time when one in three of the four million babies born each year in the United States is delivered by cesarean section, some studies have suggested that rates of unscheduled C-sections vary by race and ethnicity. Assistant Professor Joyce Edmonds and colleagues at the University of Massachusetts Medical School looked at five years of patient data from the Worcester, Mass., medical center and found that among low-risk primiparous women at the hospital, black women and Asian women were indeed more likely than white or Latino women to have undergone C-sections because of fetal distress. The researchers published their findings in the September issue of BMC Pregnancy and Childbirth.

Edmonds and her coauthors identified a dataset of 4,483 low-risk, first-time mothers who went into full-term labor with a single baby with normal (vertex) presentation and then had either spontaneous vaginal delivery (74.1 percent), operative vaginal delivery (9.2 percent), or unplanned cesarean delivery (16.7 percent). The researchers, who controlled for variables such as maternal age, body-mass index, neonate size, and primary language in their research, also found that black women were likelier than other women to undergo unscheduled cesarean deliveries because of fetal distress.

The researchers conclude that the differences in C-section rates at the academic medical center may be best explained in further study of the variation in clinical decision-making about what indicates fetal distress and failure to progress. They suggest that future research might explore that topic as well as women’s involvement in the decision-making, and variations in fetal tolerance for labor.