Retrospective Cohort Study on Racial and Ethnic Disparities in Cesarean Birth in a Midwifery-Integrated Health System.
Denise C Smith, E Brie Thumm, Zachary Giano and 4 others
PMID 41276260WHAT IT FOUND
Among term singleton vertex births in a Colorado health system, cesarean birth remained more likely for Asian, Black, Hispanic, and all other race women than White women after accounting for age, insurance, provider, and hospital region.
Midwifery care was linked to lower rates.
Key findings
01Nulliparous women identified as Asian, Black/African American, Hispanic, or all other races had higher odds of cesarean birth than non-Hispanic White women.
02Midwife-attended term singleton vertex births had a cesarean rate of 15.7%, compared with 25.3% for physician-attended births and 22.4% for the whole sample.
03Physician care was associated with higher adjusted odds of cesarean birth than midwifery care among both nulliparous and multiparous women.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It was done in one Colorado health system, so the results may not apply elsewhere. Black and Asian women were too few in some hospital regions for precise estimates or tests of how hospital and provider type interact. The study did not know whether race and ethnicity were self-reported or assigned in the record. It excluded births with medical reasons for cesarean, so it describes variation in practice rather than all medically necessary cesareans. It was observational, so it cannot show that midwifery care caused lower cesarean rates. Social, political, and environmental factors that can affect birth outcomes were not measured. Cases with missing key data were excluded.
Declared interests
The authors reported no conflicts of interest or relevant financial relationships.
The easy way to misread this
Do not read the lower cesarean rate among midwife-attended births as proof that midwifery care caused the reduction or that it eliminated racial disparities. This was an observational cohort, and adjusted odds of cesarean birth remained higher for women of color.