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Published on: June 6, 2020
Delivery mode by race for breech presentation in the US
H C Lee1, Y Y El-Sayed, J B Gould
1Department of Pediatrics, Stanford University, Stanford, CA 94304, USA. hclee@stanford.edu
Summary
Cesarean delivery rates for breech infants vary by race. After adjusting for risk factors, African-American women had similar rates to White women, while Hispanic women had higher rates.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Epidemiology
- Health Disparities
Background:
- Breech presentation occurs in approximately 3-4% of term pregnancies.
- Mode of delivery for breech presentation has been a subject of debate and evolving clinical practice.
- Cesarean delivery is the predominant mode of birth for breech infants.
Purpose of the Study:
- To investigate racial and socio-demographic disparities in cesarean delivery rates among women with breech infants.
- To identify if differences in cesarean delivery rates persist after accounting for confounding factors.
Main Methods:
- Analysis of a large national dataset (National Center for Health Statistics) of singleton breech births (N=186,727) from 1999-2000.
- Calculation of cesarean delivery rates across racial groups (White, African American, Hispanic, Asian) and gestational age.
- Application of multivariable logistic regression to adjust for socio-demographic and medical factors.
Main Results:
- Overall cesarean delivery rates for breech presentation exceeded 80% across most gestational age groups.
- Initially, White women showed higher cesarean rates than African American women, but this difference disappeared after risk adjustment.
- Hispanic women demonstrated significantly higher likelihoods of cesarean delivery compared to both African American and White women, with this disparity increasing after adjustment.
Conclusions:
- While African-American women had lower unadjusted cesarean delivery rates for breech presentation compared to White women, this disparity was eliminated after controlling for relevant factors.
- Hispanic women experienced higher rates of cesarean delivery for breech infants, a trend that was amplified post-risk adjustment.
- Asian women exhibited slightly lower adjusted cesarean rates, though significant variability was observed among different Asian subgroups.
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