Perinatal & Pediatric
Racial disparities in cesarean delivery at a rural-serving hospital in a state with limited access to obstetric services Andrew Williams* Andrew Williams University of North Dakota
Background: Cesarean delivery increases risk of complications for mothers and infants. Understanding disparities in cesarean delivery rates in a state with limited access to obstetric services is necessary to improve equity in perinatal care. Using electronic medical records (EMR), trends in cesarean delivery rates, overall and by race, were described.
Methods: EMR for 21,168 pregnancies from January 2012-December 2024 from a birthing hospital in North Dakota (ND) were analyzed. Race/ethnicity (White, American Indian/Alaska Native (AIAN), Other race) was self-reported by patients and recorded on EMR. Cesarean delivery (yes/no), and birth year (2012-2024) were indicated in EMR. Cesarean delivery rate (%) was calculated overall, by race/ethnicity, and by year. Trends were assessed using SAS proc reg. North Dakota Vital Records statewide cesarean delivery rates from the study period were used as a population-based comparison.
Results: Overall, the cesarean delivery rate was 24%. By race/ethnicity, AIAN women had the highest rate of cesarean delivery (36%), followed by Other race women (25%) and White women (23%; p<0.05). Each year, AIAN had the highest rate of cesarean delivery compared to White and Other race women (p<0.05) The rate of cesarean delivery among AIAN women was higher than the overall hospital for each year, and was higher than the ND cesarean rate for each year except 2023 (AIAN 25.9%, ND 26.5%). Trend analysis suggests the cesarean delivery rate is trending downward for all racial/ethnic groups at the birthing hospital, yet AIAN women continue to experience higher cesarean rates compared to White women and other race/ethnicity women. Cesarean rates in ND were stable across the study period (about 27%).
Discussion: Racial disparities in cesarean delivery rates were persistent across the study period, with decreasing trends for all racial/ethnic groups. Data-informed strategies to reduce cesarean deliveries among AIAN women are warranted.