In Improving Birth

According to provisional U.S. data for 2017, after four years of inching downward from 32.9% in 2013 to 31.9% in 2016, the overall cesarean rate rose by a tenth of a percentage point to 32.0% in 2017. The pain (pun intended) wasn’t distributed evenly. The rate in white women was unchanged at 30.9% but rose from 35.9% to 36.0% in black women and from 31.7% to 31.8% in Hispanic women.

The rate in 1st-time mothers at low risk for cesarean, that is, carrying one, head down, full-term baby, likewise increased by three tenths of a percentage point from 25.7% in 2016 to 26.0% in 2017. Rates rose in white women (24.7% to 24.9%) and in Hispanic women (25.1% to 25.6%) and were essentially unchanged in black women (30.3% to 30.4%); however, lack of a rise in black women is hardly good news given the glaring disparity in cesarean rates between black women (30.4%) and white (24.9%) and Hispanic (25.6%) women even in a homogenously low-risk population.

Preterm birth rates reversed direction three years ago, and they continued their upward trend in 2017, rising from 9.85% to 9.93%. Black and Hispanic babies bore the brunt of the increase, with the rate rising by 15 more babies per 1000 (13.77% to 13.92%) in black women and 16 more per 1000 (9.45% to 9.61%) in Hispanic women while remaining unchanged in white women (9.04% to 9.06%). The marked difference between black and white babies in the increase in the overall rate is especially distressing because the rate is already unconscionably high in black women compared with white women.

Add to these dismal statistics the shockingly high maternal mortality rates, especially in black women, and you have a portrait of a failed maternity system. Sadly, as the politics of health care currently stand in the U.S. and with medical-model thinkers firmly in the driver’s seat, outcomes are unlikely to improve and almost certain to get worse.

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