ArticleBMC pregnancy and childbirth2023
Disparities by race/ethnicity in unplanned cesarean birth among healthy nulliparas: a secondary analysis of the nuMoM2b dataset.
Article in BMC pregnancy and childbirth, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 16 citations in OpenAlex.
- The Association Between Experiencing Racial Discrimination and Delivery Method Among Women in the United States, PRAMS 2016-2021.Journal of racial and ethnic health disparities · 2026Article
- Racial and Ethnic Disparities in Low-Risk Unplanned Cesarean Birth: Disaggregating Asian Data.Journal of racial and ethnic health disparities · 2026Article
- Risk factors for unplanned cesarean delivery among pregnant individuals with pre-existing diabetes.Pregnancy (Hoboken, N.J.) · 2026Article
- Examining Racial and Ethnic Disparities in Low-Risk Cesarean Section Deliveries in the Colorado Healthy Start Study.Journal of racial and ethnic health disparities · 2026Article
- Racial and Ethnic Differences in Labor Duration and Cesarean Indications Among Low-Risk Nulliparous Term Singleton Vertex Births: A Retrospective Analysis.Journal of clinical medicine · 2026Article
- Visualizing the Maternal Health Journey for Learning Health Systems: Mixed Methods Combined Experience Approach.Journal of participatory medicine · 2026Article
- The psychological impact of childbirth: Unscheduled cesarean delivery associates with increased risk for acute stress response.Pregnancy (Hoboken, N.J.) · 2026Article
- Preparation, Experience of Discrimination, and Birth Experience Among Women Birthing in Ohio.The Journal of perinatal education · 2025Article
- Evaluation of Statewide Program to Reduce Cesarean Deliveries Among Nulliparous Individuals With Singleton Pregnancies at Term Gestation in Vertex Presentation.Obstetrics and gynecology · 2024Article
- Health Disparities in the Use of Primary Cesarean Delivery among Asian American Women.International journal of environmental research and public health · 2023Article
- Unplanned Cesarean for Abnormal or Indeterminate Fetal Heart Tracing Varies Significantly by Race and Ethnicity.Journal of midwifery & women's healthArticle
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundRacial disparities exist in maternal morbidity and mortality, with most of these events occurring in healthy pregnant people. A known driver of these outcomes is unplanned cesarean birth. Less understood is to what extent maternal presenting race/ethnicity is associated with unplanned cesarean birth in healthy laboring people, and if there are differences by race/ethnicity in intrapartum decision-making prior to cesarean birth.
methodsThis secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset involved nulliparas with no significant health complications at pregnancy onset who had a trial of labor at ≥ 37 weeks with a singleton, non-anomalous fetus in cephalic presentation (N = 5,095). Logistic regression models were used to examine associations between participant-identified presenting race/ethnicity and unplanned cesarean birth. Participant-identified presenting race/ethnicity was used to capture the influence of racism on participant's healthcare experiences.
resultsUnplanned cesarean birth occurred in 19.6% of labors. Rates were significantly higher among Black- (24.1%) and Hispanic- (24.7%) compared to white-presenting participants (17.4%). In adjusted models, white participants had 0.57 (97.5% CI [0.45-0.73], p < 0.001) lower odds of unplanned cesarean birth compared to Black-presenting participants, while Hispanic-presenting had similar odds as Black-presenting people. The primary indication for cesarean birth among Black- and Hispanic- compared to white-presenting people was non-reassuring fetal heart rate in the setting of spontaneous labor onset.
conclusionsAmong healthy nulliparas with a trial of labor, white-presenting compared to Black or Hispanic-presenting race/ethnicity was associated with decreased odds of unplanned cesarean birth, even after adjustment for pertinent clinical factors. Future research and interventions should consider how healthcare providers' perception of maternal race/ethnicity may bias care decisions, leading to increased use of surgical birth in low-risk laboring people and racial disparities in birth outcomes.
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