ArticleHealth services research2020
Cesarean birth and maternal morbidity among Black women and White women after implementation of a blended payment policy.
Article in Health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 3 of them syntheses that pooled it.
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Who cites it
8 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Reducing Rates of Cesarean Delivery in Rural US Communities: A Systematic Review of Interventions and Approaches to Care.Preventing chronic disease · 2026Pooled it
- Effects of Race, Ethnicity and Socioeconomic Deprivation on Postpartum Haemorrhage in High-Income Countries: A Systematic Review and Meta-Analysis.BJOG : an international journal of obstetrics and gynaecology · 2025Pooled it
- Effects of different payment methods on perinatal care outcomes: a systematic review.BMC health services research · 2025Pooled it
- Financial and regulatory interventions to reduce unnecessary caesarean sections: An updated scoping review.PLOS global public health · 2026Article
- Variation by default: cesarean section discharge opioid prescription patterns and outcomes in Military Health System hospitals: a retrospective longitudinal cohort study.BMC anesthesiology · 2022Article
- Inequities in quality perinatal care in the United States during pregnancy and birth after cesarean.PloS one · 2022Article
- Coronavirus Trauma and African Americans' Mental Health: Seizing Opportunities for Transformational Change.International journal of environmental research and public health · 2021Review
- Cesarean birth and maternal morbidity among Black women and White women after implementation of a blended payment policy.Health services research · 2020Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
objectiveTo test whether Minnesota's blended payment policy had differential effects on cesarean use and maternal morbidity among black women and white women in Minnesota, as compared to six control states. DATA SOURCES/STUDY
settingClaims data from births to Medicaid fee-for-service beneficiaries, 2006-2012, in Minnesota (policy state) and six control states (Wisconsin, Iowa, Illinois, Oregon, Idaho, and Montana). STUDY
designThe key study intervention was Minnesota's blended payment policy, which established one single payment rate for uncomplicated vaginal and cesarean births in 2009. The primary outcome was cesarean birth, and secondary outcomes were maternal morbidity (composite), postpartum hemorrhage, and chorioamnionitis. Policy effects were assessed using race-stratified comparative interrupted time series analysis. PRINCIPAL
findingsFollowing policy implementation, cesarean use decreased among both black and white women in Minnesota compared to control states; this decline was larger among black women (-2.88 percent 3-year cumulative decline, from a prepolicy cesarean rate of 22.2 percent) than among white women (-1.32 percent, P = .0013). Postpartum hemorrhage increased, with larger increases among black women (1.20 percent 3-year cumulative increase), compared with white women (0.48 percent, P < .001) in Minnesota compared with control states.
conclusionsPolicy-related declines in cesarean use after Minnesota's blended payment policy were larger in black women. Increases in postpartum hemorrhage signal potential unintended consequences of policy-related cesarean reduction.
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