Are Black mothers more likely to have unscheduled C-sections? A new working paper from the National Bureau of Economic Research suggests yes–and that their likelihood of an unscheduled C-section was greater when there were operating rooms going unused.
Same hospital, different c-section rates
While C-sections can be a lifesaving option when necessary, they are invasive surgeries that come with the risk for serious complications, including blood loss or clotting, infections, and increased risk of complications for future pregnancies. Public health organizations have been advocating for years to bring down rates of unnecessary C-sections, especially for low-risk women with no prior births.
The new report looked at nearly one million New Jersey electronic birth certificate records from 2008-2017 and found that Black mothers having unscheduled deliveries were 25% more likely to deliver by C-section compared to non-Hispanic white mothers. This finding was especially striking since Black mothers had fewer risk factors for an unscheduled C-section, generally because they were younger.
The gap remains even when mothers of a different race but similar medical histories saw the same doctor at the same hospital. “Even after controlling for medical risk, measures of socioeconomic status, hospital fixed effects, and doctor fixed effects, Black mothers remain 20.1 percent more likely to receive an unscheduled C-section than their white counterparts,” the authors write.
“These findings show that even the same doctors are treating Black patients differently.”
–National Bureau of Economic Research
Keeping the operating rooms busy
The authors found that unscheduled C-sections were more likely to happen when there were no previously scheduled procedures, indicating that the availability of operating rooms may play a role in the rate of unscheduled C-sections. When operating rooms were unavailable, the difference in unscheduled C-section rates between white and Black mothers disappeared. Furthermore, these women delivered without a subsequent rise in complication rates.
Findings like these suggest that the old saying about supply creating its own demand may be more realistic than pessimistic.
“These patterns highlight how the timing of scheduled C-sections affect decisions about whether to order unscheduled C-sections and suggest that medical necessity is not the only driver of unscheduled C-section rates.”
–National Bureau of Economic Research
Study author and Princeton University health economist Dr. Janet Currie concurred. “There is lots of evidence that if a hospital has a CT scan or an M.R.I. they like to keep it busy,” Dr. Currie said, in The New York Times. “If you have an operating room set up to do a C-section, they like to keep that busy too.”
If our goal is to provide the best possible care at the lowest possible risk to all mothers, these findings should be disturbing. Given the array of health challenges Black mothers already face, research like this should be an even stronger impetus to change.