Unplanned Cesarean for Abnormal or Indeterminate Fetal Heart Tracing Varies Significantly by Race and Ethnicity.
Elizabeth Langen, Althea Bourdeau, Jessi Ems and 2 others
PMID 39692190WHAT IT FOUND
Black and Asian or Pacific Islander birthing people in Michigan were more likely to have an unplanned cesarean for fetal heart tracing, even after patient and hospital factors were considered.
Care by certified nurse midwives was associated with fewer such cesareans, but disparities remained.
Key findings
01After controlling for covariates, Black birthing people had 1.71 times the odds, Asian or Pacific Islander birthing people had 1.55 times the odds, and people of unknown race or ethnicity had 1.23 times the odds of unplanned cesarean for fetal heart tracing compared with White birthing people.
02During active labor, having a certified nurse midwife rather than an obstetrician-gynecologist was associated with 0.71 times the odds of unplanned cesarean for fetal heart tracing after controlling for covariates.
03Racial disparities persisted after controlling for active labor provider type, with Asian and Black birthing people at the highest adjusted risk.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study did not include fetal heart tracing reviews, so it could not directly measure bias or racism in how tracings were interpreted. Race and ethnicity were used as a proxy for experiencing racism, not as a direct measure of racism or bias. The provider type analysis was unplanned and post hoc. The analysis could not account for all possible confounders, such as epidural anesthesia use. The study did not verify the midwifery practice model or provider race and ethnicity. Race and ethnicity data may have been misclassified or missing because patient-reported collection was not always followed. The study looked only at the cesarean indication, not psychological safety, preferences, or respectful care.
Declared interests
Blue Cross Blue Shield of Michigan and the Blue Care Network funded the Obstetrics Initiative and provided salary support to four authors. The funders were aware of the publication but did not write or edit the manuscript.
The easy way to misread this
Do not read the higher cesarean rate as evidence that Black birthing people need cesareans for biological reasons. The authors used race as a proxy for experiencing racism, not as a biological marker. They also did not review fetal heart tracings, so the study cannot show that bias directly caused the higher rate.