Damning New Study Reveals Hospitals’ Bias With Black Mothers and C-Sections

The deafening cries of Black women whose pain has been doubted, delayed or flat-out ignored have now been acknowledged in a new study that examines disparities in maternal health.

That’s right. As pregnant Black women have been recorded writhing in pain during active labor in waiting rooms and forced to give birth in cars, researchers at Oregon Health & Science University’s (OHSU) Center for Women’s Health found a rising national trend of cesarean births for Black women, despite an overall decrease in cesarean births — or C-sections — for other groups.

A cesarean section, often called a C-section, is a surgical procedure that delivers a baby through incisions in the abdomen and uterus rather than through the birth canal, according to the Cleveland Clinic. It is typically used when a medical concern makes vaginal birth unsafe for the parent or baby. While the procedure can be lifesaving, it is still major surgery with a longer recovery time and more potential complications than a vaginal birth.

The OHSU study found that the upward trend of cesarean sections among Black women is significant even when their medical situations are the same as those of other racial and ethnic groups.

Here’s a breakdown of the study’s key findings for Black individuals:

• Risk of cesarean was 12% higher in 2012 and rose to 17% higher in 2021.
• For first-time births, the risk of cesarean was 20% higher in 2012 and rose to 23% higher in 2021.

• For mothers who had a prior vaginal birth and no prior cesarean, the risk of cesarean was 32% higher in 2012 and rose to 33% higher in 2021.

The study, led by Marie Boller, M.D., an OBGYN and maternal-fetal medicine specialist in OHSU’s Center for Women’s Health, analyzed more than 30 million U.S. births from 2012 to 2021.

“There are many reasons why someone might come into a labor and delivery unit and need a cesarean delivery — it’s a critically important, life-saving procedure — but race is not one of them,” Boller said, via OHSU News. “These findings are cause for concern, because we know these disparities have no biological basis and are rooted in structural racism.”

Researchers emphasized that closing this gap will require work at every level of maternal care. Dr. Aaron Caughey, M.D., Ph.D., the study’s senior author, notes that implicit bias is a major factor in clinicians’ decisions. Recognizing these troubling disparities, he references OHSU’s active efforts to create change in maternal health care by reviewing each cesarean delivery on a “case-by-case basis” and identifying opportunities to improve patient care.

Caughey noted that institutions must invest in ongoing bias training, routinely review cesarean decisions and diversify the health care workforce through pipeline programs that reflect impacted communities.

Boller added that progress requires a “collective effort among obstetric providers.” According to OHSU News, Boller concluded, “Moving the cesarean rate down happens one family at a time, one conversation at a time.”