A recent study found that black mothers are more likely to have unnecessary C-sections than mothers of other races.
The study, published in August 2024, collected information on nearly one million births at 68 hospitals in New Jersey and found that black mothers were 25% more likely to have a C-section than white mothers. Essentially, doctors are more willing to perform unnecessary C-sections on black mothers if they can afford it.
This highlights the importance of physician discretion and suggests that many physicians may set a lower bar for elective C-sections for black mothers. Although statistics are limited, the study found that black physicians are less likely than white physicians to perform additional C-sections on black mothers.
The study considered several factors that may increase the likelihood of having a C-section, including medical risk factors, sociodemographic characteristics, hospital, physician group or practice, and, other things being equal, C-section rates remain higher for black women.
These results are rooted in medical bias
Absent these medical risk factors, this disparity in C-section births can only be attributed to medical bias and racism, says Dr. Jasmine Johnson.
“For example, if a medical organization holds the erroneous belief that black women are less likely to have a successful vaginal birth (which is certainly not based on medical fact), that organization’s implicit or explicit bias may make them less likely to spend more time with black birth patients than white birth patients,” she explains.
Dr. Ilogu Igbinosa agrees, acknowledging that the causes of racial disparities in cesarean births and maternal care in the United States are complex and multifactorial: “Race is a social phenomenon and construct (not biologically determined), and racial disparities in pregnancy outcomes often reflect racism rather than race.”
Dr. Igbinosa further explained that the disproportionately higher C-section rates among black mothers could be the result of implicit or explicit bias, highlighting that studies have shown that black mothers often have their concerns ignored or dismissed during childbirth.
“In this new study, the authors point out that the reasons for caesarean sections were not recorded and so they cannot rule out the existence of ‘unmeasured factors’ such as interpersonal relationships, stigma and discrimination,” Dr Igbinosa added.
Black Mothers at Risk
Dr. Igbinosa takes into account the fact that the vaginal birth after cesarean calculator has historically made black women less eligible to be tested for vaginal birth after cesarean.
“Thus, mothers who undergo an unnecessary C-section may be more likely to have a C-section in future pregnancies,” she concluded. “In 2021, the American College of Obstetricians and Gynecologists’ VBAC calculator was adjusted to eliminate racial bias.”
Dr. Johnson points out that after one C-section, subsequent births, whether vaginal or C-section, are more complicated, and each C-section increases the risk of life-threatening pregnancy complications.
She also explained that while a C-section can be a safe way to deliver a baby if necessary, it is a major abdominal operation that carries risks, including more bleeding than a vaginal birth, risk of wound infection, and more pain than a vaginal birth.
A 2019 study published in the Canadian Medical Association Journal found that people who had a C-section were more likely to experience complications than those who had a vaginal birth, potentially leading to life-threatening health issues for the mother.
Cesarean sections are not only dangerous for the woman giving birth, they also pose risks to the baby: A 2018 study found that children born by Cesarean section were at higher risk of asthma by age 12 and at higher risk of obesity by age 5.
What can you do?
Johnson said studies like this are important because they allow the medical community to assess its own personal biases and ensure systems are in place to promote equity, such as tracking C-section rates at hospitals and analyzing data by race and ethnicity, so that such trends can be identified and corrected.
“For Black mothers, I don’t think it’s our responsibility to fix the system, but it never hurts to be equipped with strategies to advocate for equitable care prenatally and during birth,” she advises.
Dr. Igbinosa recommends:
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- Create a birth plan. Developing a pre-birth plan with your obstetrician/midwife/prenatal care provider will allow you to ask questions about different what-if options during birth. There are several templates and apps available online, and your healthcare provider’s office may also have examples.
- Consider a doula or birth support. Studies show that many mothers benefit from support during labor and delivery. Explore options available through local community groups, hospitals, and prenatal and postnatal clinics. Some insurance companies offer doulas as a partially covered benefit, and nonprofit organizations offer free or low-cost doulas to those who meet eligibility criteria.
- Ask questions throughout the process. A C-section may be necessary, especially if there is an urgent problem with the woman or the fetus. You can ask your medical team questions about your treatment and to understand (or ask why) decisions and procedures.
- Know the signs of maternal distress. Familiarize yourself with national campaigns like the CDC’s Hear Her Campaign and local advocacy efforts from community groups like the Black Mamas Matter Alliance. These resources educate parents about the symptoms of emergency warning signs in mothers.
- Tell your story. Consider making your voice heard about the future of maternity care on community advisory boards at local hospitals, research boards, and nonprofit organizations.
Dr. Igbinosa noted that there is growing recognition that more can be done to reduce C-section rates for Black people. She explained that there are now quality efforts being made at the local, state and national levels to reduce not only C-section rates but also the apparent disparities.
“To specifically address racial inequities, we must first acknowledge they exist,” she said, “and even more importantly, work with the communities most affected to create safer birth experiences.”
