Low-risk cesarean birth : racial/ethnic disparities, multilevel factors, and the potential to reduce downstream severe maternal morbidity
Abstract/Contents
- Abstract
- Cesarean birth is the most common surgical procedure in the United States and is a life-saving intervention when medically indicated. Cesarean birth is also associated with perinatal risks such as infection and post-partum depression and increases the risk of cesarean delivery in subsequent births. Among low-risk births, typically defined as nulliparous, term, singleton, and vertex (NTSV), the overuse of cesarean birth can be an indicator of poor quality of care. It is particularly concerning that there are disparities in the prevalence of low-risk cesarean birth, with racially and socioeconomically marginalized populations experiencing the highest risk of NTSV cesarean birth. To this end, we explore two key objectives using population-based data from California: (1) assess the contributions of multi-level factors, in particular the role of hospital and ZIP code level socioeconomic disadvantage, to racial/ethnic disparities in low-risk cesarean rate, where race/ethnicity is considered a social factor and a proxy for structural racism, and (2) assess the downstream impact of low-risk cesarean birth (as a potentially modifiable risk factor) on severe maternal morbidity (SMM) in the next pregnancy. In Chapter 2, we examine the contribution of birth hospital to racial/ethnic disparities in low-risk cesarean births, under the premise that a lower risk-adjusted hospital-level cesarean birth rate is an indicator of better quality of care. We use G-computation substitution to estimate how racial/ethnic variability in low-risk cesarean changes if racially minoritized populations (contrary to what is observed) give birth at the same distribution of hospitals as White individuals. In Chapter 3, we investigate the combined effect of race/ethnicity and socioeconomic disadvantage on low-risk cesarean birth via an interaction analysis, first by identifying groups most at risk of cesarean birth based on race/ethnicity and socioeconomic disadvantage and second by assessing how racial/ethnic disparities in low-risk cesarean birth vary across levels of socioeconomic disadvantage. In Chapter 4 we investigate how low-risk cesarean birth among primiparous individuals impacts their risk of SMM in the next pregnancy. We conduct a counterfactual impact analysis to quantify the decrease in subsequent SMM that could occur if there were a decrease in low-risk cesarean first birth. These chapters provide evidence of the contribution of multi-level factors such as birth hospital and socioeconomic disadvantage to racial/ethnic disparities in low-risk cesarean birth as well as evidence that lowering cesarean delivery among low-risk births can prevent subsequent maternal morbidities.
Description
| Type of resource | text |
|---|---|
| Form | electronic resource; remote; computer; online resource |
| Extent | 1 online resource. |
| Place | California |
| Place | [Stanford, California] |
| Publisher | [Stanford University] |
| Copyright date | 2024; ©2024 |
| Publication date | 2024; 2024 |
| Issuance | monographic |
| Language | English |
Creators/Contributors
| Author | Bane, Shalmali Sunil |
|---|---|
| Degree supervisor | Carmichael, Suzan L. (Suzan Lee) |
| Degree supervisor | Simard, Julia |
| Thesis advisor | Carmichael, Suzan L. (Suzan Lee) |
| Thesis advisor | Simard, Julia |
| Thesis advisor | Odden, Michelle |
| Degree committee member | Odden, Michelle |
| Associated with | Stanford University, School of Medicine |
| Associated with | Stanford University, Department of Epidemiology and Population Health |
Subjects
| Genre | Theses |
|---|---|
| Genre | Text |
Bibliographic information
| Statement of responsibility | Shalmali Bane. |
|---|---|
| Note | Submitted to the Department of Epidemiology and Population Health. |
| Thesis | Thesis Ph.D. Stanford University 2024. |
| Location | https://purl.stanford.edu/jv957fy9177 |
Access conditions
- Copyright
- © 2024 by Shalmali Sunil Bane
- License
- This work is licensed under a Creative Commons Attribution Non Commercial 3.0 Unported license (CC BY-NC).
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