{"id":21511,"date":"2024-10-08T08:00:00","date_gmt":"2024-10-08T13:00:00","guid":{"rendered":"https:\/\/naturalwomanhood.org\/?p=21511"},"modified":"2024-12-02T06:59:09","modified_gmt":"2024-12-02T12:59:09","slug":"%d1%87%d0%b5%d1%80%d0%bd%d1%8b%d0%b5-%d0%b6%d0%b5%d0%bd%d1%89%d0%b8%d0%bd%d1%8b-%d0%ba%d0%b5%d1%81%d0%b0%d1%80%d0%b5%d0%b2%d0%be-%d1%81%d0%b5%d1%87%d0%b5%d0%bd%d0%b8%d0%b5","status":"publish","type":"post","link":"https:\/\/naturalwomanhood.org\/ru\/black-women-c-section\/","title":{"rendered":"\u0427\u0442\u043e \u0433\u043e\u0432\u043e\u0440\u044f\u0442 \u0434\u0430\u043d\u043d\u044b\u0435 1 \u043c\u0438\u043b\u043b\u0438\u043e\u043d\u0430 \u0440\u043e\u0434\u043e\u0432 \u043e \u0432\u0435\u0440\u043e\u044f\u0442\u043d\u043e\u0441\u0442\u0438 \u043a\u0435\u0441\u0430\u0440\u0435\u0432\u0430 \u0441\u0435\u0447\u0435\u043d\u0438\u044f"},"content":{"rendered":"\n

Low-risk black women are 25% more likely<\/em> to undergo C-sections than their white counterparts: that\u2019s the concerning conclusion of a 2024 bombshell report<\/a> from the National Bureau of Economic Research (NBER). <\/p>\n\n\n\n

After analyzing nearly 1 million births from 68 hospitals in New Jersey between 2008 and 2017, NBER also found that low-risk black women were particularly likely to end up with C-sections during times when operating rooms were sitting empty<\/em>. Some (including The New York Times<\/em>, which first broke the story) have blamed financial motives and systemic racism for the disparity. But what more can this data tell us? And what can be done to reduce C-section rates for everyone, and particularly for black women whose maternal mortality rates are already disturbingly high?  <\/p>\n\n\n\n

Who did the research?<\/span><\/h2>\n\n\n\n

The NBER research was conducted by a Northwestern University researcher, a Princeton University researcher, and a North Carolina State University Economics professor. According to their curriculum vitaes, the Northwestern and North Carolina researchers originally studied under the Princeton researcher. The report was a working paper, which means it has not been peer-reviewed. However, the researchers meticulously documented their methodology. <\/p>\n\n\n\n

The researchers sought to answer \u201cthe question of why Black infants are more likely to be delivered by Cesarean section (C-section) than white infants in the United States.\u201d The researchers observed, \u201cWe use exceptionally rich administrative data covering nearly one million births in New Jersey from 2008 to 2017 to understand the causes of racial disparities in delivery method.\u201d <\/p>\n\n\n\n

New Jersey\u2019s C-section data is representative of national data<\/span><\/h3>\n\n\n\n

What should our national C-section rate look like? The World Health Organization (WHO) recommends<\/a> that a country\u2019s C-section rate should not exceed 10-15%. But lest anyone wonder if racial disparities in C-sections are a uniquely New Jersey problem, the researchers also cited data from the National Vital Statistics Survey showing that 29.3% of all births by white mothers and 34% of all births by black mothers across the U.S<\/em>. were via C-section in 2018. In 2023, 1 in 3 births<\/a> across the country was via C-section. <\/p>\n\n\n\n

Mark Simon, MD, chief medical officer at Ob Hospitalist Group (OBHG) recently told Healthline<\/a>, \u201cThe CDC has released data<\/a> that clearly highlights national differences in C-section rates across each state, with New Jersey ranking on the high end. But this problem is not unique to New Jersey\u2014disparities in maternal mortality, particularly along racial and socioeconomic lines, are also well-documented.\u201d<\/p>\n\n\n\n

What did the researchers find?<\/span><\/h2>\n\n\n\n

A note about the language used in the NBER report is in order. \u2018Unscheduled delivery\u2019 refers to a birth in which the woman did not have a planned C-section, but planned to have a vaginal birth. The NBER report found that the unscheduled C-section rate (i.e., intended vaginal births that ended up becoming C-section births) among Black mothers in New Jersey was 21.1 percent compared to 16.9 percent among non-Hispanic white mothers. According to the report, this means that \u201con average, Black mothers with an unscheduled delivery are 24.8 percent more likely to have an unscheduled, or \u2018emergency,\u2019 C-section\u201d compared to white mothers.\u201d Shockingly, \u201cEven when treated by the same physician in the same hospital<\/em>, Black mothers with unscheduled deliveries are 20.1 percent more likely than observationally similar white mothers to deliver by C-section\u201d (emphasis added). <\/p>\n\n\n\n

\u201cEven when treated by the same physician in the same hospital, Black mothers with unscheduled deliveries are 20.1 percent more likely than observationally similar white mothers to deliver by C-section.\u201d<\/p>National Bureau of Economic Research<\/cite><\/blockquote><\/figure>\n\n\n\n

Importantly, the researchers noted that \u201cthe higher C-section rate among low-risk Black mothers is primarily driven by unscheduled C-sections,\u201d not <\/em>planned C-sections. The researchers further wrote, \u201cStrikingly, Black mothers with unscheduled deliveries in the lowest risk quintile are 149.4 percent (p-value < 0.001) more likely to have a C-section than white mothers.\u201d <\/strong><\/p>\n\n\n\n

What can be done to decrease unnecessary C sections, particularly on black women? <\/span><\/h2>\n\n\n\n

A key element in driving down C-section rates, especially among low-risk black women, is likely to be found in allowing normal, physiologic birth to unfold\u2013in other words, to not \u201crush the process\u201d of birth.<\/em> From coast to coast, awareness is spreading of the key role<\/a> midwives play in educating women before labor on what to expect, and then supporting them through labor, trusting (and verbalizing to women) that their bodies are capable of giving birth[1]. Doulas are also pivotal players in decreasing C-section rates<\/a>. <\/p>\n\n\n\n

From coast to coast, awareness is spreading of the key role midwives play in educating women before labor on what to expect, and then supporting them through labor, trusting (and verbalizing to women) that their bodies are capable of giving birth<\/p><\/blockquote><\/figure>\n\n\n\n

States across the country would do well to sit up and take notice of the aggressive measures<\/a> being taken in New Jersey to drive down C-section rates. Starting in 2018, New Jersey implemented a pilot doula program. Since 2021, New Jersey Medicaid has covered doula care, and stopped paying for elective C-sections<\/em>. Also in 2021, the Nurture NJ Strategic Plan<\/a> was released, recommending statewide implementation of comprehensive informed consent processes ensuring every mother understands the short-term and long-term risks of having a C-section. The Plan further recommended limiting participation in insurance networks for hospitals who don\u2019t meet C-section target rates. Furthermore, New Jersey has established a first-in-the-nation policy of universal newborn nurse home visitation\u2013meaning that recovering new moms needn\u2019t figure out how to venture out to the pediatrician with their baby in tow during the vulnerable days following birth.\u00a0<\/p>\n\n\n\n

The bottom line<\/span><\/h2>\n\n\n\n

At Natural Womanhood, we understand that respect for the female body occurs on a continuum. It is illogical and inconsistent to, on the one hand, value the gift of a woman\u2019s fertility and cycles\u2014understanding that we ought not alter, suppress, or destroy them\u2014but on the other hand fail to recognize the inherent wisdom of her pregnant and birthing body. Certainly, medical interventions\u2014including emergency obstetric surgery\u2014exist for those cases when they are vitally necessary. But as the NBER report underscores, greater discretion around the use of C-sections (and, perhaps, the interventions that are more likely to lead to them<\/a>) is an urgent priority for those concerned with improving maternal health outcomes and satisfaction. <\/p>\n\n\n\n

[Editor\u2019s note: For more on the factors the 2024 NBER report found that influenced C-section rates for black women, click here<\/a>.]<\/em><\/p>\n\n\n\n

References:<\/span><\/h3>\n\n\n\n[1] Hanahoe M. Midwifery-led care can lower caesarean section rates according to the Robson ten group classification system. Eur J Midwifery. 2020 Mar 31;4:7. doi: 10.18332\/ejm\/119164. PMID: 33537609; PMCID: PMC7839114.<\/p>\n\n\n\n

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