Tuesday, October 6, 2009

Likelihood of a primary cesarean delivery is greatest for African Americans

Reuters reports, October 2nd, on a new Kaiser Permanente study examining the racial and ethnic disparities that occur with cesarean delivery, and notes that the study found 'disproportionately higher rate of primary c-sections among African-American women'.

The Californian study, Racial and Ethnic Disparities in the Trends in Primary Cesarean Delivery based on Indications, found that 'compared to Caucasian women, African-American women had significantly higher rates of primary CS while the increase in rates among
Hispanic women was smaller'.

What the study found
Further, it is reported that the disparity 'cannot be explained by education, smoking
during pregnancy, when prenatal care began or maternal age at delivery', and the lead author, Darios Getahun, MD, MPH, continues: 'This study underscores the importance of educating expectant women about the potential impact of CS on the outcome of future pregnancies.'

The figures published in the study's Abstract look at percentage increases in the primary cesarean rate, rather than percentage actual occurence, and it is unclear at first glance what women should do with this information. Perhaps the Full Text would prove a more useful read for African Americans - for example, it would be useful to know how many of these primary cesareans were emergency and how many were planned.

What the study tells African American women
This is the big question, and the answer is quite complex. Does the research call for better preparation for and best practice support during labor, in order to increase the likelihood of vaginal delivery? Or does it suggest that, if a women is likely to 'very likely to end up having surgery anyway', perhaps she'd be better having planned rather than emergency surgery?

Obviously, part of the answer can be found in the woman's personal birth preference, if she has one, and also, very importantly, how many children she is planning to have over the course of her life. Because however her primary cesarean occurs, through medical necessity or through choice, it is highly likely that she will go on to have further surgery in future pregnancies, and of course the health risks increase with multiple cesareans.

As a final note, the study results also note that 'Indication subtypes-specific rates of primary cesarean section varied markedly across race/ethnicity', and again, access to the study's Full Text would be useful for these women.

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