Racial and Ethnic Trends in Cesarean Delivery on Maternal Request

To evaluate race and ethnicity differences in rates of cesarean delivery on maternal request (CDMR) in nulliparous, term, singleton, vertex presentation (NTSV) cesarean deliveries.

We conducted a retrospective cohort study of NTSV cesarean deliveries within our institution from 2016 to 2020. The primary outcome was CDMR and the primary predictor was maternal race and ethnicity. Multivariable logistic regression models were used to evaluate associations between race and ethnicity, CDMR, and various maternal and perinatal factors.

Among 12,351 NTSV cesarean deliveries, 594 (4.81%) underwent CDMR; 4605 (37.28%) identified as non-Hispanic White, 3731 (30.21%) as Asian/Hawaiian/Pacific Islander, 2840 (22.99%) as Hispanic, 785 (6.36%) as Black, and 390 (3.16%) as multiple races/American Indian/Alaskan Native. Adjusted models showed increased odds of CDMR among non-Hispanic White people. Multiple races/American Indian/Alaskan Native people had the lowest odds of CDMR compared to non-Hispanic White people (adjusted OR [aOR] = 0.48, 95% CI 0.26-0.82), followed by Asian/Hawaiian/Pacific Islander (aOR = 0.58, 95% CI 0.47-0.72), Black (aOR = 0.61, 95% CI 0.40-0.89), and Hispanic (aOR = 0.70, 95% CI 0.55-0.88) people.

Non-Hispanic White people undergo CDMR more frequently compared to Asian/Hawaiian/Pacific Islander, Black, and Hispanic people. Our findings are notable in light of the growing body of research demonstrating that White people have the lowest odds of cesarean delivery overall.

Profound racial disparities in maternal obstetric outcomes exist in the United States. It is well established that non-Hispanic Black people have disproportionately higher cesarean birth rates and higher rates of birth complications, including maternal death. Racial and ethnic differences in rates of primary elective cesarean delivery, or cesarean delivery on maternal request, are not well understood. This research shows that non-Hispanic White people have more cesarean deliveries on maternal request than other racial and ethnic groups among low-risk nulliparous patients.