At the International Doula Institute, we are committed to being part of the solution to improve poor maternal health outcomes in the US. We know that at the root of some of our poor outcomes is disparities in care. Sadly, a recent study showing Black mothers are more likely to receive unnecessary c-sections when compared to their peers, did not surprise us.
Why are we not surprised? Part of our training and at the core of our organization is being aware of disparities in care and the importance of diversity, equity, and inclusion. Our curriculum includes information and history about how these disparities came to be, and how birth workers can be support their clients in reducing individual risks. We already suspected this type of care.
Let us be clear: the issue is very much systemic, and doulas are not the solution to the problem. However, with training and education, our doulas can help their clients navigate the unfair biases in care which can exist.
The large study of nearly 1 million births at 68 hospitals in New Jersey, researchers found that obstetricians are more likely to perform unnecessary C-sections on Black mothers when compared to white mothers. Shockingly, Black women were 25% more likely to give birth via a c-section.
When we consider that Black women are 3-4 times more likely to die from pregnancy and childbirth related complications, we have to wonder, what impact is unnecessary surgery having on those numbers?
Black Women More Likely To Have an Unnecessary C-Section
As doulas, one of the things we tell our clients is to be mindful of what providers they choose and what birthing facility they opt to go to. What is most concerning about the research, it did not seem that there was a significant difference in risk of c-section for Black women based on their provider and chosen hospital.
The published research stated:
“Black mothers with unscheduled deliveries are 25 percent more likely to deliver by C-section than non-Hispanic white mothers. The gap is highest for mothers with the lowest risk and is reduced by only four percentage points when controlling for observed medical risk factors, sociodemographic characteristics, hospital, and doctor or medical practice group.”
Regardless of which hospital Black women in this study chose, they still had a significant risk factor of a c-section birth, even as low risk individuals. This research ultimately confirms what other evidence suggests, biases in care (both conscious and unconscious), and systemic racism play a significant role in birth outcomes and the disparities Black women face.
What is concerning is there was also evidence that hospital costs played a role in these disparities. “Remarkably, the gap disappears when the costs of ordering an unscheduled C-section are higher due to the unscheduled delivery occurring at the same time as a scheduled C-section.”
Are hospitals using Black women to make more money when the c-section schedule is light?
This Study Highlights The Impact of Racism and Biases in Care And Their Impact on Birth Outcomes
Discussing racism, disparities, biases in care and other sensitive topics can at times lead to disbelief, and even gaslighting, that it is a problem in US maternity care. However, even the CDC recognizes that systemic racism plays a role in disparities in care.
The researchers stated, “This finding is consistent with provider discretion—rather than differences in unobserved medical risk—accounting for persistent racial disparities in delivery method. The additional C-sections that take place for low-risk women when hospitals are unconstrained negatively impact maternal and infant health.”
Meaning, there is pretty clear evidence that these biases in care directly impact health outcomes for birthing people and infants. These disparities are the direct result of how people receive care and not evidence-based medical risk necessitating birth by c-section. Providers are not giving equal care. Health systems are harming Black women and infants.
What Does This Information Mean For Doulas?
As mentioned above, it is not possible for nor is it appropriate for doulas to be responsible for changing disparities in care. The issues in maternal child health outcomes are far above doulas. However, with the right education, training, and resources, we can help our clients navigate a broken system.
We can help clients understand their options, their right to self-advocacy, and we can help affirm them in a way they cannot be successfully gaslit. One way we as birth workers can prepare to best support our clients is through educating ourselves about the why behind these disparities.
IDI offers a Diversity, Equity, and Inclusion certificate for birth workers interested in learning how to help clients navigate racism, prejudices, discrimination related to disabilities, nationality and more.
Doulas focus on each individual client and help them have a safer birth. You can read more about this study in the New York Times: Doctors Give Black Women Unneeded C-Sections to Fill Operating Rooms, Study Suggests
Author: Maria Silver Pyanov, CPD, CCE
Maria Silver Pyanov, CPD, CCE has been serving prenatal and postpartum families since 2007.