Doctors Are Giving Unneeded C-Sections To Black Moms In NJ: Study

NEW JERSEY — “Unacceptable. Deeply disturbing. Dangerous.” These were some of the reactions from advocates after hearing about a new study that suggests that obstetricians are giving many Black mothers in New Jersey unnecessary cesarean sections – potentially putting their health at risk.

The study from the National Bureau of Economic Research (NBER) – one of the largest of its kind – took a look at data from nearly a million births in New Jersey from 2008 to 2017. It included a special focus on cesarean sections, also known as C-sections, which are used to deliver a baby through surgical incisions made in the abdomen and uterus.

Read the full study here.

According to the U.S. Centers for Disease Control and Prevention, C-sections account for about 30 percent of all deliveries in the United States. For many women, they are a safer alternative when a vaginal birth can’t be done safely. But like any surgery, the procedure comes with risks, including infection, blood loss, blood clots or potential complications in future pregnancies.

And according to the study from the NBER, they are risks that Black women are facing at a much higher rate in New Jersey:

“Black mothers with unscheduled deliveries are 25 percent more likely to deliver by C-section than non-Hispanic white mothers. The gap is highest for mothers with the lowest risk and is reduced by only four percentage points when controlling for observed medical risk factors, sociodemographic characteristics, hospital, and doctor or medical practice group. Remarkably, the gap disappears when the costs of ordering an unscheduled C-section are higher due to the unscheduled delivery occurring at the same time as a scheduled C-section. This finding is consistent with provider discretion—rather than differences in unobserved medical risk—accounting for persistent racial disparities in delivery method. The additional C-sections that take place for low-risk women when hospitals are unconstrained negatively impact maternal and infant health.”

First Lady Tammy Murphy was among those who said they are worried about the implications of the study – and what it means for an ongoing mortality gap among New Jersey mothers and babies.

“I am deeply grateful for this research which confirms exactly what we found when we first came to Trenton in 2018: horrific maternal mortality rates alongside persistent racial disparities dictating outcomes,” Murphy said.

According to recent studies, Black babies born in the state are three times more likely to die before their first birthdays than white infants. Black mothers are seven times more likely than white mothers to die from pregnancy-related complications. Meanwhile, Hispanic women in New Jersey experience twice the rate of infant mortality compared to white women.

Ironically, New Jersey is doing very well when it comes to its overall infant mortality rate, which was recently measured as the fifth-lowest in the nation. See Related: New Jersey's Black Infants, Moms Face ‘Mortality Gap’

Murphy – who has acknowledged her own advantages as a white woman with “money in our family’s bank account” – said the state has been working on the mortality gap over the last six years, and has made “tremendous progress.”

“We have ended Medicaid reimbursement of early elective C-sections, brought transparency through the Report Card of Hospital Maternity Care, expanded Medicaid coverage for a full year postpartum, became the third state to ensure Medicaid coverage for doula care and the first state to ensure community-based doula training, established the first-of-its-kind Maternal and Infant Health Innovation Authority, shared-decision making, mandated implicit bias training and more,” she said.

“However, we know that our work to tackle persistent racial disparities is far from over,” Murphy added.

“The findings in this study are wholly unacceptable and deeply disturbing,” the first lady continued. “We have long known that Black mothers are more likely to undergo unscheduled C-sections compared to white mothers, but this study confirms the historical, large-scale statistical racial disparities in delivery methods, without a correlation to medical risk.”

• See Related: Here’s The Plan To Fix New Jersey’s 'Racist' Infant Mortality Gap
• See Related: Newark Infant Death Rate Falls As NJ Fights ‘Shameful’ Race Gap

The study also hit hard for Nastassia Harris, the founder of the Perinatal Health Equity Initiative, a nonprofit advocacy group based in East Orange.

In a recent email, Harris referenced an article in The New York Times, which analyzed the study and penned a heavy headline: “Doctors Give Black Women Unneeded C-Sections to Fill Operating Rooms, Study Suggests.”

“While I saw the article making the rounds, I didn't click on until a friend shared and I was floored to learn the article was talking about New Jersey,” Harris recalled.

“In a state where we have invested millions to address the maternal health crisis and have no documented improvement in the pregnancy outcomes for Black women must do better,” Harris urged.

According to Harris, the study also shows how bias in health care leads to Black women being systematically dismissed or pushed into more invasive, riskier procedures.

• See Related: NJ Doula Shares 5 Stigmas That Pregnant Black Women Face

“The driving force behind these disparities is clear: systemic racism,” Harris wrote. “Medical racism has long been embedded within the health care system, resulting in the undervaluing of Black women’s lives, health, and autonomy. From mismanagement during labor to the overuse of surgical interventions like C-sections, Black women’s bodies are too often treated as if they don’t matter.”

“New Jersey’s maternal health care system is no exception,” Harris asserted. “The state consistently ranks among the worst for Black maternal health outcomes despite its wealth and resources. This racial injustice is a national shame, and it's time we confront it head-on.”

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