Racial bias in cesarean decision making

• DOI: 10.54053/001c.92657
• Publication Date: 2024-02-13T18:24:52Z
• Authors: Sarah Edwards; Quetzal Class; Catherine Ford; Tamika Alexander; Jonah Fleisher
• Keywords: Labor, Obstetric; Cesarean Section; Clinical Decision-Making; White; Vaginal Birth after Cesarean; 01 natural sciences; United States; Obstetrics; Black or African American; Racism; Pregnancy; Humans; Female; 0101 mathematics

PURPOSE:Since Black patients have higher rates of cesarean birth, and implicit racial bias in clinical decision-making has been demonstrated multiple contexts, we sought to determine if is present providers' decisions about birth due category II fetal heart tracings. METHODS:We constructed an online survey study consisting two scenarios labor with tracings.One vignette described a patient history (undergoing trial after cesarean, or TOLAC); one without this history.Patient race was randomized White; vignettes were otherwise identical.Participants had the option continue proceed at 3 decision points each scenario.Participants reported their own demographics anonymously.This distributed OB-GYN providers via email, listserv, social media.Data analyzed using chi-square tests point looking first overall sample then subgroup analyses by various participant demographics.In analysis, investigated differences provider type (e.g.resident, fellow, attending) practice setting. RESULTS:A total 726 participants contributed study.We did not find significant overall.However, found that attending physicians more likely opt for 3rd describing TOLAC.In addition, fellows less delivery TOLAC Bonferroni-corrected post-hoc [X2 (228)=14.18,p<.01].Responders role as "other" non-TOLAC (245)=14.15,p<.01].We note perform section across setting.CONCLUSIONS: Providers demonstrate our analysis.Participants based on setting.Attending undergoing TOLAC.Participants identifying themselves cesarean-decision making.In than other when making nulliparous patient.