Racial and Ethnic Disparities in Low-Risk Unplanned Cesarean Birth: Disaggregating Asian Data

Cesarean outcomes are rarely investigated by Asian ethnicities when examining variation among low-risk, first-time birthing parents. We analyzed a clinical birth dataset of Northwestern U.S. hospitals to evaluate disparities in unplanned cesarean births among disaggregated Asian ethnicities.

This cross-sectional study used chart-abstracted birth data from 2017 through 2021. Analysis restrictions included hospitals reporting for the full timeframe, and patients who were nulliparous, term, singleton, vertex presentation, allowed to labor without a scheduled cesarean birth, and not intrapartum transfers or community births. Adjusted and unadjusted multi-level logistic regression compared the primary outcome of unplanned cesarean birth by race and Asian ethnicities.

A total of 40,160 births met inclusion criteria; 21.3% were Asian. Overall, the laboring cesarean rate was 23.1%, ranging from 33.9% for South Asians to 17.0% for East Asians. Compared to Whites, South Asians (OR 1.84, CI 1.66-2.04), Southeast Asians (OR 1.28, CI 1.05-1.55), and Asian unspecified (OR 1.27, CI 1.18-1.37) had significantly higher unadjusted odds of cesarean birth while East Asians had significantly lower odds (OR 0.73, CI 0.63-0.86). Odds for South Asian cesarean birth were more than doubled that of White births (aOR 2.18, CI 1.95-2.44) in the adjusted model.

After controlling for known risk factors, South Asians had elevated odds for unplanned cesarean birth compared to other races and ethnicities, despite lower risk factor incidence. Medical systems should collect disaggregated race and ethnicity data to provide pregnancy management insights for reducing inequities in low-risk unplanned cesarean births.