New Study Shows Black Mothers Are More Likely Than Others To Receive Unnecessary C-Sections

A recent study shows that Black mothers are more likely to undergo unnecessary C-sections than ones of other racial groups.

The study, published in August 2024, gathered information from nearly 1 million births at 68 hospitals in New Jersey and found that Black mothers were 25% more likely to deliver by C-section than white mothers. Essentially, doctors are more willing to do unnecessary C-sections on Black mothers when there is the capacity to do so.

This highlights the importance of doctor discretion and reveals that many may set a lower threshold for performing unscheduled C-sections on Black mothers. Despite limited statistics, the study interestingly suggests Black doctors are less likely than white doctors to do additional C-sections on Black mothers.

The study controlled some of the factors that could make someone more likely to have a cesarean delivery, including medical risk factors, sociodemographic characteristics, hospital, and doctor or medical practice group. With all things being equal, Black women still had a higher rate of cesarean.

Medical Bias is the Basis for These Results

Jasmine Johnson, MD, says that in the absence of these medical risk factors, we are only left to attribute this inequity in cesarean delivery to bias and medical racism.

“For example, a medical team may inaccurately hold the belief that Black women are less likely to have successful vaginal deliveries (definitely not rooted in any medical fact), and so the implicit or explicit bias of the team may lead them to be less likely to give Black patients more time to progress in labor compared to their white counterparts,” she explains.

Irogue Igbinosa, MD, agrees, acknowledging that the causes of racial disparities in C-sections and maternal care in the U.S. are complex and multifactorial. “Race is a social phenomenon and construct (not biologically defined), and often, racial disparities in pregnancy outcomes reflect racism instead of race.”

Dr. Igbinosa goes on to explain the disproportionate C-sections among Black mothers could be a result of implicit and/or explicit bias—and that multiple studies have underscored Black mothers often felt their concerns had been ignored or dismissed during labor.

“In this new study, the authors noted the reasons for C-section were not listed and they could not rule out the presence of 'unmeasurable factors,' such as interpersonal interactions, bias, and discrimination," adds Dr. Igbinosa.

The Risk to Black Mothers

Dr. Igbinosa considers the fact that the vaginal birth after cesarean calculator previously made Black women less eligible for a trial of vaginal labor post-cesarean.

“Therefore, a mother who received an unnecessary C-section may have been more likely to have a repeat C-section with future pregnancies," she concludes. "In 2021, the American College of Obstetrics and Gynecology VBAC calculator was modified to remove racial bias.”

Dr. Johnson notes once someone has a cesarean delivery, it makes future deliveries more complicated, whether vaginal or via C-section. And with each subsequent cesarean delivery, there is a higher risk of life-threatening pregnancy complications such as placenta accreta.

She also explains that while cesarean deliveries can be a safe way to deliver a pregnancy when needed, it is a major abdominal surgery with risks such as more bleeding compared to a vaginal delivery, risk of wound infections, and increased pain compared to a vaginal birth.

A 2019 study from the Canadian Medical Association Journal found that those who had C-sections were more likely to have complications than those who delivered vaginally, and suffer potentially life-threatening maternal health problems.

C-sections aren’t just a risk for those giving birth—they also pose a potential risk for their children. A 2018 study found that children delivered by cesarean delivery had an increased risk of asthma up to the age of 12 and obesity up to the age of 5.

What Can Be Done?

Dr. Johnson says studies like these are so important because they allow the medical community to evaluate their own personal biases and make sure that systems are in place to promote equity, such as tracking cesarean delivery rates at hospitals and disaggregating the data by race and ethnicity so trends like this can be identified and corrected.

“For Black mothers, I do not think that it is on us to fix the system, but it never hurts to equip yourself with strategies to advocate for equitable care during your prenatal care and labor,” she advises. 

Dr. Igbinosa recommends: 

• Create a birth plan. Working with your obstetrician/midwife/prenatal care provider on a plan before delivery allows you to ask questions about the different hypothetical options in labor. Several templates and apps are available online; and your health care provider's office may also have examples. 
• Consider labor/doula support. Research suggests support during delivery is helpful to many mothers. Look into the options available through community-based organizations, hospitals, and prenatal/birth clinics near you. Some insurance companies have doulas as a partially/covered benefit, and non-profit organizations offer doulas at no cost/low cost to those meeting eligibility criteria. 
• Ask questions throughout. Some may need a C-section, particularly if there is an urgent issue affecting either the pregnant person or baby. It's OK to ask your health care team questions about your care and for understanding (or the rationale) of any decisions or procedures.
• Know the urgent maternal signs. Familiarize yourself with national campaigns, including the CDC's Hear Her Campaign, and local advocacy efforts from community-based organizations, such as Black Mamas Matter Alliance. These resources educate parents about the symptoms of urgent maternal warning signs.
• Tell your story. Consider adding your voice to provide input on the future of maternity care with community advisory boards at your local hospital, research committees, and non-profit organizations.

Dr. Igbinosa observes that there is a growing recognition that more can be done to reduce the C-section rates among Black people. She explains that currently, there are quality initiatives at the local, state, and national level working to reduce not just the C-section rate, but also the evident disparities.

“In order to specifically address the racial disparities, you first have to be aware the problem exists," she says. "It’s even more important to partner with the communities most affected to achieve safer birth experiences.“