Last Updated on November 23, 2024 by Successful Black Parenting Staff

A recent study from the National Bureau of Economic Research (NBER) suggests that Black women are disproportionately subjected to unnecessary C-sections (Caesareans) in the U.S. This alarming trend raises significant concerns about racial bias, financial incentives for hospitals, and harmful stereotypes that may be contributing to poor maternal care for Black women, and even higher mortality rates.

Disproportionate C-Section Rates for Black Women

Black women in the U.S. experience significantly higher C-section rates than white women, even when accounting for factors like medical history and socioeconomic status. While C-sections can be lifesaving in certain situations, a substantial portion of the procedures performed on Black women are deemed unnecessary. This suggests that racial bias, stereotypes, and systemic healthcare inequalities may be influencing medical decisions, resulting in surgeries that are not medically warranted.

The study reveals that Black women are disproportionately affected by these unnecessary interventions. Combine this with the high rates of maternal mortality rates of Black women and this additional disparity exposes deep-rooted issues within the U.S. healthcare system that must be addressed.

“The study suggests that hospitals may schedule C-sections to increase their revenue, filling operating rooms, and disproportionately targeting Black mothers for these procedures.”

Financial Incentives Drive Higher C-Section Rates

One of the most concerning findings from the NBER study is the role of financial incentives in the overuse of C-sections. Hospitals typically make more money from C-sections than from vaginal deliveries, as the procedures are more expensive. Unfortunately, this creates a scenario where some healthcare providers may prioritize profit over the well-being of Black mothers, leading to a higher number of unnecessary surgeries.

The study suggests that hospitals may schedule C-sections to increase their revenue, filling operating rooms, and disproportionately targeting Black mothers for these procedures. This profit-driven model puts Black women at a greater risk of experiencing surgical complications from procedures that are not essential.

Racial Bias in the Delivery Room

Implicit racial bias among healthcare providers plays a significant role in the elevated rates of C-sections for Black women. These biases manifest in the form of stereotypes that lead to unnecessary medical interventions. Some of the most common harmful stereotypes include:

1. Larger Babies: There is a persistent stereotype that Black women are more likely to have larger babies, which can lead doctors to recommend early inductions or C-sections without sufficient medical justification. This misconception puts Black mothers at risk of unnecessary surgeries.
2. Increased Likelihood of Complications: Another harmful stereotype is that Black women are more prone to complications during childbirth. While Black women do face higher rates of maternal mortality due to systemic inequalities, this stereotype is often applied without evidence, influencing doctors to perform unnecessary C-sections.
3. Higher Pain Tolerance: The false belief that Black women have a high pain tolerance has contributed to harmful medical practices. It can lead to inadequate pain management during labor, which in turn increases the likelihood of unnecessary C-sections. When pain is not properly addressed, it can stall labor or cause physical exhaustion, leading doctors to opt for surgical intervention. Additionally, the delayed recognition of potential complications due to this bias can escalate the situation, making a C-section appear necessary when better pain management or timely care could have resulted in a natural birth. This harmful assumption ultimately contributes to the overuse of C-sections in Black mothers.

Dana Sherrod, MPH, the Co-Founder and Executive Director at CA Coalition for Black Birth Justice, said, “History shows us that Black women’s bodies have been sites of exploitation and experimentation. We see this in history with medical experimentation on enslaved Black women, and more recently with forced or coerced sterilization. I think unfortunately medical racism has been perpetuated over generations and is alive and well today. That can show up in a variety of ways in the delivery room, like not being listened to, pain being ignored, being pressured into procedures and interventions, and a greater likelihood of performing c-sections.”

Steps to Protect Yourself and Advocate for Your Health

“I believe that new parents and support persons can begin advocating for themselves during pregnancy by establishing a maternal child health team, beginning with a midwife,” said Jadah Parks Chatterjee, BSN, IBCLC, a registered nurse, and a lactation consultant and one of the Coalitions’ Strategic Advisors at CA Coalition for Black Birth Justice. “It is important that parents learn what is normal, thereby enhancing their recognition of what’s not normal, and know when to seek support. This education is also a fundamental part of their maternal advocacy toolkit, fostering conversation between patients and providers, asking questions, and providing informed consent.  I believe partnering with a Midwife is an essential ingredient to increasing this knowledge, confidence, and better birthing outcomes.” 

For new and expecting Black parents, it’s crucial to be informed and proactive to avoid unnecessary C-sections and ensure the best possible outcomes. Here are some steps you can take to advocate for yourself during childbirth:

1. Educate Yourself: Knowing your options and rights as a patient is essential. Learn about when C-sections are medically necessary and familiarize yourself with the risks of unnecessary procedures.
2. Choose a Supportive Healthcare Team: Find healthcare providers who respect your birth plan and listen to your concerns. Consider hiring a doula or midwife, who can advocate for you and ensure that your wishes are respected throughout the birthing process.
3. Ask Questions: If a C-section is recommended, ask your doctor for the specific reasons behind the decision. Inquire about alternative options and don’t hesitate to seek a second opinion if something doesn’t feel right.
4. Prepare a Birth Plan: A well-thought-out birth plan can help you maintain control over your labor and delivery. Share this plan with your healthcare team and make sure it outlines under what circumstances you would consider a C-section.
5. Stay Assertive: Trust your instincts, and don’t be afraid to advocate for yourself. If you feel that a procedure is being pushed unnecessarily, speak up. Having a trusted family member or friend present during labor can also help advocate on your behalf.
6. Research Hospital C-Section Rates: Before choosing where to give birth, research the C-section rates at your local hospitals. If a facility has a particularly high rate of C-sections, ask about their protocols to reduce unnecessary procedures.

The Path Forward

The findings from the National Bureau of Economic Research expose a critical issue in maternal healthcare that disproportionately affects Black mothers. By understanding the risks of unnecessary C-sections and taking proactive steps to advocate for themselves, Black mothers and their families can work toward safer, healthier births. It’s time for the healthcare system to recognize these biases and implement changes that prioritize the well-being of all mothers, regardless of race.

By standing firm and advocating for themselves in the delivery room, Black mothers can take control of their birth experiences and ensure their voices are heard. Meanwhile, the healthcare industry must address these systemic disparities to ensure that no one is subjected to unnecessary surgeries based on profit or bias.

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