Childbirth is one of the most transformative experiences a woman can have. As a mother of two, I can tell this firsthand while childbirth is deeply personal, the decision-making process during pregnancy is often influenced by external pressures more than many realize.
For the first time, I became frightened of being pregnant. According to Biomedcentral, 6% to 10% of pregnant women experience an extreme type of fear. As my own anxiety grew, I began to wonder: Would I need a C-section (CS) too? The idea of going under the knife was not something I had planned for.
Today, many Black women have questions about C-sections, especially as they become increasingly common in our community. Is a C-section always necessary for Black women, or are there factors at play that are contributing to its rise?
I want to explore the statistics surrounding C-sections in Black women, the purpose behind them, the pressures women face to undergo the procedure, and how we can advocate for our rights during pregnancy.
The Alarming Statistics: Why More Black Women Are Going Under the Knife
According to WHO, C-sections now account for 21% of global births in 2021. This statistic means one in every five child deliveries is through CS. The value is expected to go up to 29% by 2030. In their 2016-2018 method of delivery report, the CDC reported that 32.1% of pregnant women delivered through CS. This is an astonishing 1,178,066 births against 2,486,963 vaginal births in the years under review.
Fast-forward to 2023, according to March of Dimes Peristas, CS in the United States increased from 32.1% to 32.3%, and it is also expected to grow by 2030.
But what is the CS rate in our community?
Research published by the National Institutes of Health (NIH) in 2015 reveals a disparity I find quite disturbing. Cesarean section rates are much higher among Black women, with 36.8% undergoing the procedure. This is 4.1% higher than the rate for women of other racial groups, who have a CS rate of 32.7%.
Let’s put this in perspective—Black women are more likely to go under the knife than women of different races. More recent statistics from the March of Dimes Perostas 2021-2023 put the average of Black women delivered through CS at 36.8%, while Whites and Hispanics are 31.1% and 31.8%, respectively.
Let’s highlight some reasons for this disparity:
- Systemic Racism and Bias in Healthcare: Black women face discrimination and unequal treatment in medical settings, with a staggering 22% less likely to receive pain medication than white patients, and 21% reporting unfair treatment due to their race, which increases their likelihood of undergoing C-sections
- Limited Access to Prenatal Care and Health Education: Black women often have limited access to quality prenatal care, health education, and resources
- Higher Rates of Underlying Health Conditions: Black women are disproportionately affected by underlying health conditions, including hypertension (58% vs 43% for white women), diabetes (12.1% vs 6.9% for white women), and obesity (79.6% vs 67.4% for white women), increasing their risk of C-sections
- Cultural and Socioeconomic Factors: Cultural beliefs, socioeconomic status, and insurance coverage all play a significant role in their choices and access to care
The Purpose of C-Section
In a 2022 publication by the NIH, it is clearly stated that vaginal birth is the preferred method of delivery, with CS being a riskier procedure reserved for situations where vaginal birth is not possible. Some reasons why a doctor might recommend CS include:
- Fetal Distress: When oxygen supply to the fetus is compromised
- Placental Issue: Such as placental abruption
- Prolonged Labor: When labor stalls, it can endanger the child, mother, or both
- Specific Maternal Health Conditions: Including gestational diabetes or preeclampsia
While CS is necessary for these reasons, it raises the question, why Black women opt for non-emergency situations? Importantly, are they given a choice?
Convenience Over Care
In 2024, the New York Times conducted a thorough study of almost a million births in 68 hospitals in the State of Jersey. They reported that doctors are more likely to perform unnecessary CS operations on Black women. The report concluded that Black women are 20% more likely to be booked for CS by obstetricians compared to their White counterparts.
It didn’t matter if both women had similar medical histories and were using the same hospital. CBS News put this value at 25%.
The bias from doctors that leads to unnecessary CS operations on Black women may stem from various factors, including:
- Implicit bias: Unconscious stereotypes and prejudices can influence doctors’ decisions
- Financial incentives: Recent study suggests that some doctors conducted more C-sections on Black patients when their operating rooms were not in use
- Lack of cultural competency: Doctors may not fully understand or appreciate the cultural differences and values of Black women
- Clustering by race or ethnicity: When pregnant women of the same racial or ethnic background are concentrated in a particular hospital, they often receive similar treatment
- Stereotyping: Doctors may assume Black women are higher-risk patients or more prone to complications
- Lower Risk Tolerance: Healthcare providers may have lower risk tolerance for Black women, using stricter thresholds for diagnosing fetal distress
- Defensive medicine: Fear of litigation or professional repercussions may lead doctors to recommend unnecessary C-sections
The Ramifications of C-Section: What Women Should Know
Without a doubt, CS can be life-saving for both mother and child. However, it is a major surgery that comes with its complications. Here are some key things to consider before undergoing this procedure:
- Physical Recovery: Recovery from CS generally takes longer than vaginal delivery and may be accompanied by complications and infections
- Future Pregnancies: Multiple CSs may increase the risk of placenta previa, uterine rupture, or adhesions in subsequent pregnancies
- Emotional Impact: A 2017 NIH report reveals that some women who have undergone a CS feel disappointed by their lack of control of their childbirth experience
- Scarring: A CS will leave permanent scars, which can lead some women to feel self-conscious about their bodies, prompting them to seek cosmetic procedures
Advocate for Your Rights
Every Black woman has the right to make informed decisions about her body and her childbirth experience. You can advocate for your rights in the following ways:
- Educate yourself on both vaginal and CS deliveries
- Ask your healthcare provider questions about risks and CS alternatives
- Seek a second opinion for confirmation or further clarification
- Hire a doula if you can afford it so that you can get all the support you need
- Create a birth plan and share it with your healthcare provider
Empowering Women through Informed Choices
C-sections are a crucial part of obstetrics and have saved millions of lives. However, they are often overused among Black women, highlighting the need for urgent advocacy and change. By educating yourself, asking the right questions, and demanding respect for your body, you can take control of your childbirth experience.
At Elevate Black Health, we encourage you to always remember that your voice matters in one of the most significant experiences of your life.
For further research, visit:
- https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0655-4
- https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access
- https://www.cdc.gov/nchs/fastats/delivery.htm
- https://www.marchofdimes.org/peristats/data?reg=99&top=8&stop=86&lev=1&slev=1&obj=9&dv=ms
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4386542/#:~:text=Cesarean%20rates%20were%20significantly%20higher,of%20particular%20risk%20factors%20varied.
- https://www.marchofdimes.org/peristats/data?reg=99&top=8&stop=356&lev=1&slev=1&obj=1
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9168579/
- https://www.nytimes.com/2024/09/10/health/cesarean-sections-black-women.html
- https://www.cbsnews.com/boston/news/c-sections-black-mothers-new-york-times/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6366841