Racial bias in cesarean decision-making

Area of Science:

• Obstetrics and Gynecology
• Clinical Decision-Making
• Health Equity

Background:

• Category II fetal heart tracings are a common reason for cesarean delivery in the US, with subjective interpretation.
• Black patients experience higher rates of cesarean delivery, including for Category II tracings.
• Racial bias in clinical decision-making is a documented issue in obstetrics.

Purpose of the Study:

• To investigate whether racial bias influences provider decisions for cesarean delivery in cases of Category II fetal heart tracings.
• To examine potential disparities in cesarean delivery recommendations based on patient race.

Main Methods:

• An online survey study presented 2 clinical scenarios with Category II fetal heart tracings.
• Patient race was randomized between Black and White in identical vignettes.
• Providers made decisions on labor continuation or cesarean delivery at 3 points; data analyzed via chi-square tests.

Main Results:

• No significant overall racial bias in cesarean delivery decisions was found among 726 participants.
• In a previous cesarean delivery scenario, providers under 40 and with less than 10 years of experience were more likely to opt for cesarean delivery for Black patients early in labor.
• Cesarean delivery rates equalized across patient races as labor progressed in that scenario.

Conclusions:

• Younger providers and those with less experience exhibited racial bias in early labor decision-making for cesarean delivery in specific circumstances.
• This bias was not observed as labor progressed or in scenarios without a history of cesarean delivery.
• The study suggests potential links to historical use of race in clinical prediction tools and calls for further investigation and interventions.