Hispanic women living in the United States’ southwest-border region have a cesarean rate that is higher than that of other Hispanic women in the border states and U.S. Hispanic women overall, a research team at New Mexico State University has discovered.
Published in the health care journal Health Affairs, the research shows that 38.3 percent of births in 2015 by Hispanic women living in border-region counties, spanning California, Arizona, New Mexico and Texas, were cesarean. By contrast, the Hispanic cesarean rate in the rest of the border states was 30.9 percent. Hispanic rates also far exceeded non-Hispanic white rates on the border.
The findings reflect a reversal of the situation in years past, said Jill McDonald, NMSU public health sciences professor, who led the research team that conducted the study, which was funded by a $100,000 grant from the Health Resources and Services Administration.
“Prior to 2013, Hispanic women had lower cesarean rates than non-Hispanic white women in the U.S.,” said McDonald, who serves as the director of the Southwest Institute for Health Disparities Research in the College of Health and Social Services at NMSU. “Now, Hispanic women are more likely to have a cesarean birth than non-Hispanic white women.”
In the Health Affairs publication, NMSU researchers tried to identify the causes of disparities in cesarean deliveries by Hispanic women on the border. McDonald and the research team, which included Charlotte Gard, NMSU associate professor of applied statistics, Anup Amatya, former NMSU associate professor of public health sciences, and Jesus Sigala, former NMSU graduate student of applied statistic, used a database of U.S. births from 2015 from the National Vital Statistics System.
The study examined 187 counties in California, Arizona, New Mexico and Texas where births occurred. According to the study, the overall cesarean rate in the 23 border counties was 38.3 percent. In the 164 non-border counties, the overall cesarean rate was 30.9 percent – almost 8 percent less than the rate in border counties. Even among low-risk women with no previous cesareans, 31.2 percent had cesarean deliveries.
In Southern New Mexico counties, overall cesarean rates ranged from 22 to 40 percent, while some counties in West and South Texas had rates of more than 48 percent. “The outcomes were generally worse for Texas than the other border states,” Gard said.
According to the study, maternal characteristics, such as the proportions with breech births, prenatal medical risk factors and getting prenatal care in the first trimester, explained more than 50 percent of the county-level variation in cesarean rate. Other major contributors to higher cesarean rates included: for-profit hospital status, delivery by a physician as opposed to a midwife and living in a county with a large Hispanic population.
McDonald also believes cultural factors might contribute to high cesarean rates among Hispanic women living in the U.S. border region. The women’s proximity to Mexico, which has an overall higher rate of cesarean deliveries than the U.S., could be a factor, she added.
Given the risk factors associated with cesarean deliveries, the increased rates are worrisome, McDonald said.
“A cesarean is good if you need it. But if it’s not necessary, both mother and baby would be better without it,” she said. “Women giving birth in high-rate counties are probably facing higher risks. And, those women will face those risks again in subsequent cesarean deliveries. After you have one, almost all women will only have cesarean deliveries for subsequent pregnancies.”
McDonald said figuring out the best way to reduce cesarean rates can be challenging. Gard said some states have experimented with lowering reimbursements to hospitals and providers for cesarean deliveries, which are currently higher than for vaginal births. Other states require women to get a second opinion before having a cesarean birth.
“It’s not going to be one easy solution. We’re going to need a multifaceted strategy that works for women, hospitals and state legislators,” McDonald said, adding that interventions should also address cultural factors.
The study notes that a strategy with cultural sensitivity might include: bilingual education in prenatal care that lays out the risks and benefits of cesarean delivery; public reporting of hospital-specific cesarean rates in English and Spanish; and measures to remove barriers to the management of labor and delivery by doulas or certified nurse midwives.
To read an abstract of the study, visit http://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05369 .
Information from NMSU