Centering Birth Equity in Cesarean Delivery

PRIHSM - NIH Maternal Health Research Center of Excellence

Almost 1 in 3 U.S. childbirths are cesarean births, rates varying 10-fold across hospitals, and Black and Asian individuals having the highest prevalence of cesarean birth among low-risk pregnancies. While cesarean birth can be a lifesaving intervention when appropriate, it is associated with significant risks that include postpartum hemorrhage. We propose that enhanced birth equity and reduced variability in obstetric management are important strategies in addressing disparities in cesarean-linked postpartum hemorrhage and reducing postpartum hemorrhage-related severe maternal morbidity.

Aim 1. Identify strategies to reduce disparities in rates of cesarean birth and cesarean-associated postpartum hemorrhage using mixed methods.

Previously we identified large variation in hospital cesarean rates among Black patients. Using qualitative and quantitative methods we are working to identify strategies to reduce disparities in rates of cesarean birth and cesarean-associated postpartum hemorrhage.

Aim 2. Validate and curate action tools and resources in the Maternal Equity Guide.

Following two years of collaborative work with pilot hospitals and community groups through CMQCC, the project team will refine and validate action tools, such as a Culture of Equity Survey, and methods to collect patients' hospital experiences.

Aim 3. Expand implementation of the Maternal Equity Guide in state-wide efforts to reduce disparities in rates of cesarean birth and cesarean-linked postpartum hemorrhage.

The project team will deploy multiple strategies for the implementation of the Maternal Equity Guide.

Aim 4. Assess the effectiveness of the Maternal Equity Guide and implementation strategies.

Using continuous quality improvement approaches, the project team will assess the effectiveness of and recommend tweaks to the Maternal Equity Guide and the implementation strategies.

Project Team

Elliott Main, MD
Principal Investigator
Alex Butwick, MD, MS
Sarah Garrett, PhD
Nan Guo, PhD
Melissa Rosenstein, MD, MAS
Kendra Smith, PhD
Shen Chih-Chang, PhD
Jeffrey Gould, MD
Ruhi Nath, MPH
Pervez Sultan, MD
Amanda P. Williams, MD, MPH
Terri Deeds, RN, MSN
Leslie Kowalewski
Susan Perez, MPH, PhD
Christa Sakowski, RN