ArticleJournal of obstetric, gynecologic, and neonatal nursing : JOGNN2026
Retrospective Cohort Study on Racial and Ethnic Disparities in Cesarean Birth in a Midwifery-Integrated Health System.
Article in Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo examine factors associated with cesarean birth by race and ethnicity in a health system with a large proportion of midwife-attended births.
designRetrospective cohort study using electronic heath record data.
settingA multihospital regional health system of community and academic hospitals on the Colorado Front Range.
participantsData from the births of women admitted for labor and birth from January 1, 2018 to January 31, 2020 (N = 10,473).
methodsWe identified cesarean births and categorized them by maternal race and ethnicity and the type of provider who managed the labor. We used descriptive statistics to characterize the sample. We used multivariable logistic regression to examine associations among cesarean birth, maternal race and ethnicity, and provider type accounting for hospital geographic location, maternal age, and insurance status by parity.
resultsCesareans accounted for 13% of total births and 22.4% of births among nulliparous women with term singleton pregnancies with the fetus in vertex position. Nearly 33% of total births were attended by midwives. Compared with non-Hispanic White women, odds of cesarean birth were significantly higher for nulliparous Black/African American women (odds ratio (OR) = 1.55, 95% confidence interval (CI) [1.13, 2.13], p < .05), Asian women (OR = 1.54, 95% CI [1.02, 2.32], p < .05), Hispanic women (OR = 1.36, 95% CI [1.11, 1.65], p > .05), and women of all other races (OR = 1.70, 95% CI [1.27, 2.27], p < .001) as well as multiparous Hispanic women (OR = 1.60, 95% CI [1.18, 2.25], p < .05) and multiparous women of all other races (OR = 2.60, 95% CI [1.64, 4.13], p < .001). Cesarean birth was more likely when a physician compared with a midwife managed the labor course in nulliparous births (OR = 1.38, 95% CI [1.30, 1.50], p < .001) and multiparous births (OR = 1.60, 95% CI [1.36, 1.90], p < .001).
conclusionAlthough overall rates of cesarean birth were low in comparison with state and national averages, racial disparities persisted. Our study findings are aligned with those from previous studies in which researchers demonstrated lower use of cesarean birth with midwifery care and reinforce the importance of examining multilevel influences on cesarean birth.
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