Black and Latinx women more likely to experience serious complications in planned repeat caesareans

Black and Latinx women are more likely to face serious complications during planned repeat caesareans than White women, new US research has found.

While complication rates were similar across all racial and ethnic groups for vaginal births after a previous caesarean, disparities emerged in outcomes for those having planned repeat surgery.

Researchers examined severe maternal morbidity – serious complications during childbirth that can have lasting health effects – across 72,836 births between 2012 and 2021 among people who had previously delivered by caesarean.

The team analysed data from the Massachusetts Pregnancy to Early Life Longitudinal Data System, focusing on births following an earlier caesarean.

The 21 complications tracked include outcomes such as hysterectomy (removal of the womb), heart attack, embolism (blood vessel blockage), kidney failure, eclampsia (seizures in pregnancy linked to high blood pressure), sepsis (a life-threatening infection), and complications related to anaesthesia.

Laura Attanasio is associate professor of health policy and management and lead author of the study.

She said: “There’s been increasing recognition in recent years that the US has this rising rate of severe maternal morbidity, which can have a negative impact on one’s health in the future.”

It also can be considered a near miss for maternal mortality, or death, which is also high in the US relative to other wealthy countries, though rare.

The study examined three birth scenarios: vaginal birth after caesarean (VBAC), planned repeat caesarean, and unplanned repeat caesarean – where someone intends to deliver vaginally but ultimately requires surgery.

Attanasio said: “Among White birthing people, severe maternal morbidity rates were similar for VBAC and for planned repeat caesarean.

“But for Black and Latinx birthing people, planned repeat caesarean had a higher rate of severe maternal morbidity compared to VBAC.”

Among all groups, the highest rate of complications occurred during unplanned repeat caesareans.

In this category, however, disparities between racial and ethnic groups were not observed.

The study population was 56.8 per cent White, 20.1 per cent Latinx, 11 per cent Black and 12.1 per cent who identified as another race or ethnicity.

The researchers used hospital discharge and birth records to identify medical issues and demographic data including race, ethnicity and parental birthplace.

They adjusted for medical risk factors more commonly associated with marginalised groups, suggesting other influences may be contributing to the differences in outcomes.

Attanasio hypothesised that “quality of clinical care can be worse for people from marginalised racial and ethnic groups, either because they’re being cared for in settings that are lower resourced and less able to provide quality care, or in some cases they could be receiving worse care in the same setting as White birthing people due to structural or interpersonal racism.”

The findings suggest the need to identify and address factors contributing to higher complication rates among Black and Latinx individuals during planned repeat caesareans.

“Future work should identify interventions to improve quality of care and promote equity for this population,” the researchers said.