Researchers at the University of Massachusetts Amherst who examined the births between people with previous sections of Caesaria found higher rates of “severe maternal morbidity” (or serious complications that could have lasting effects on health) among blacks and Latinos who suffered a planned cesarean section, compared to white.
Severe maternal morbidity (SMM, acronym in English), as defined by diseases control and prevention centers, covers 21 unexpected results from birth, including: hystelectomy, heart attack, embolism, renal failure, eclampsia, sepsis, anesthesia complications and much more.
“ In recent years, it has become more and more recognized that the United States has a growing rate of severe maternal morbidity, which can have a negative impact on future health, ” said Laura Attanasio, an associate professor of policies and health management at the Faculty of Public Health and Health Sciences at Massachusetts University, and the lead author of the study published recently on the Jama Open Network. “This can also be considered a risk factor for maternal mortality, which is also high in the United States compared to other rich countries, although it is rare.”
The racial and ethnic disparities in the previous cesarean section (SMM) have been well documented and previous studies have identified racial and ethnic differences in the birth type after a previous cesarean section. However, the intersection between race and ethnicity, the type of birth and the SMM in people with a previous cesarean section has not been examined. The purpose of this study was to characterize the association between the type of birth and the SMM in people with a previous cesarean section and to examine if this association varies by race and ethnicity.
The research team discovered that severe maternal morbid rates were similar to all racial and ethnic groups when a vaginal birth (known as PVDC, vaginal delivery after a cesarean section) occurred after a previous cesarean section. However, this did not happen with a repeated planned cesarean section.
“Among the whites that gave birth, severe maternal morbid rates were similar to PVDC and for repeated cesarean section,” said Attanasio. “However, for the blacks and Latin who gave birth, the repeated cesarean section had a higher rate of severe maternal morbidity compared to the PVDC.”
Between all the groups, the Caesarean Rate (SMM) birth rate was larger in those who had a repeated unplanned cesarean section, that is, those who started working with the intention of a vaginal birth, but finally had another cesarean section. “Between the repeated cesarean section and vaginal deliveries after a cesarean section, there was no difference between racial and ethnic groups,” said Attanasio.
The research team examined 72,836 births between 2012 and 2021, after a previous Caesarean section, using records of the longitudinal system of the Massachusetts pregnancy system in early childhood. The racial and ethnic composition declared by the participants themselves was: 56.8 % white, 20.1 % Latin, 11 % black and 12.1 % identified with another race or ethnicity. The data included hospital download records that revealed SMM, as well as other medical problems, and birth certificates that provided racial and ethnic data, the birthplace of parents and other details.
The results suggest the need to identify and address the factors that contribute to the highest SMM rates between black and Latin people with repeated scheduled cesarean section. “Future works must identify interventions to improve the quality of care and promote the equity of this population,” says the article.
Attanasio claims that the research team controlled factors such as medical risks associated with marginalized groups. She hypothesizes that “the quality of clinical care can be worse for people in racial and marginal ethnic groups, either because they receive attention in environments with less resources and less capacity to provide quality care or because, in some cases, they could receive worse care in the same environment as whites that give birth due to structural or interpersonal racism.”
Translated by Damaris Pérez Pizarro