Racial and Ethnic Disparities in Severe Maternal and Neonatal Morbidity and Labor Practices

Overview

This study analyzed data from 184 California hospitals (2015-2018) to assess racial and ethnic differences in births at hospitals with lower-interventional labor practices among low-risk nulliparous patients. Findings showed Black and Latino individuals were less likely to deliver at lower-interventional hospitals, and severe maternal and neonatal morbidity rates varied by race and ethnicity, with American Indian and Alaska Native individuals experiencing the highest severe morbidity.

Background

Racial and ethnic disparities in severe maternal and neonatal morbidity are well-documented and linked to structural racism and inequities in healthcare quality. Differences in hospital labor and delivery practices may contribute to these disparities, especially among low-risk nulliparous patients. The American College of Obstetricians and Gynecologists recommends minimal intervention during labor for low-risk patients to improve outcomes. Understanding how hospital practices vary by race and ethnicity can help identify opportunities for quality improvement and reduce disparities.

Data Highlights

Key Findings

• Black and Latino low-risk nulliparous individuals were least likely to deliver at hospitals with lower-interventional labor and delivery practices (17% and 16%, respectively).
• American Indian and Alaska Native and White individuals had the highest proportion of births at lower-interventional hospitals (29% each).
• Severe maternal and neonatal morbidity was most frequent among American Indian and Alaska Native individuals.
• Counterfactual analysis suggested that if all births occurred at lower-interventional hospitals, racial and ethnic disparities in severe maternal and neonatal morbidity would modestly increase, except for severe neonatal morbidity among AI/AN individuals.
• Hospital labor and delivery practices differ by race and ethnicity and may contribute to disparities in maternal and neonatal outcomes.

Clinical Implications

Clinicians and healthcare systems should recognize that racial and ethnic disparities in severe maternal and neonatal morbidity are influenced by differences in hospital labor and delivery practices. Efforts to standardize and improve lower-interventional labor practices across hospitals, while addressing structural inequities, may be necessary to reduce disparities. However, simply increasing births at lower-interventional hospitals may not uniformly reduce disparities and requires nuanced quality improvement strategies.

Conclusion

Racial and ethnic disparities in severe maternal and neonatal morbidity among low-risk nulliparous patients are partially related to differences in hospital labor and delivery practices. Addressing these disparities requires targeted improvements in hospital practices alongside broader structural changes.

References

1. California Maternal Quality Care Collaborative, 2015-2018 -- Data on hospital labor and delivery practices and morbidity outcomes
2. American College of Obstetricians and Gynecologists (ACOG) -- Recommendations on low-interventional labor practices