Trends in Hispanic and non-Hispanic white cesarean delivery rates on the US-Mexico border, 2000-2015

McDonald, Jill A.; Amatya, Anup; Gard, Charlotte C.; Sigala, Jesus

doi:10.1371/journal.pone.0203550

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…Black women have higher cesarean delivery rates than white women even after adjusting for patient factors and despite similar labor management. 4,5,6,7 Previous models to guide clinician decision making were developed based on data available on admission for labor and could not account for dynamic processes (e.g., cervical changes, membrane status, fetal position or station) also predictive of delivery outcome. 8,9 Artificial intelligence (AI) and its subset machine learning (ML) have been used in various medical domains to analyze problems in which an enormous number of factors interact and must be concurrently considered to predict an outcome.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Applying Automated Machine Learning to Predict Mode of Delivery Using Ongoing Intrapartum Data in Laboring Patients

et al. 2022

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OBJECTIVE To develop and validate a machine learning model to predict the probability of a vaginal delivery (Partometer) using data iteratively obtained during labor from the electronic health record. STUDY DESIGN A retrospective cohort study of deliveries at an academic, tertiary care, hospital from 2013-2019 who had at least 2 cervical exams. The population was divided into those delivered by physicians with nulliparous term singleton vertex (NTSV) cesarean delivery rates < 23.9% (Partometer cohort) and the remainder (Control cohort). The cesarean rate among this population of lower risk patients is a standard metric by which to compare provider rates; <23.9% was the Healthy People 2020 goal. A supervised automated machine learning approach was applied to generate a model for each population. The primary outcome was accuracy of the model developed on the Partometer cohort at 4 hours from admission. Secondary outcomes included discrimination ability (ROC-AUC), precision-recall AUC, and calibration of the Partometer. To assess generalizability, we compared the performance and clinical predictors identified by the Partometer to the Control model. RESULTS There were 37,932 deliveries during the study period; after exclusions, 9,385 deliveries were included in the Partometer cohort and 19,683 in the Control cohort. Accuracy of predicting vaginal delivery at 4 hours was 87.1% for the Partometer (ROC-AUC 0.82). Clinical predictors of greatest importance in the stacked Intrapartum Partometer Model included the Admission Model prediction and ongoing measures of dilatation and station, which mirrored those found in the Control population. CONCLUSION Using automated machine learning and intrapartum factors improved the accuracy of prediction of probability of a vaginal delivery over both previously published models based on logistic regression. Harnessing real-time data and machine learning could represent the bridge to generating a truly prescriptive tool to augment clinical decision making, predict labor outcomes, and reduce maternal and neonatal morbidity

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Section: Accepted Manuscriptmentioning

confidence: 99%

“…Black women have higher CD rates than White women even after adjusting for patient factors and despite similar labor management. 4 5 6 7…”

mentioning

confidence: 99%

Applying Automated Machine Learning to Predict Mode of Delivery Using Ongoing Intrapartum Data in Laboring Patients

et al. 2022

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“…Cesarean rates are particularly high for Hispanic women who live near the United States‐Mexico border 11 . The incidence of cesarean birth in primiparous Hispanic women who are at low risk for complications during childbirth is higher for those living in border regions (35.9%) compared with those who live in nonborder regions (29.1%) 12 .…”

Section: Introductionmentioning

confidence: 99%

Integrative Review of Disparities in Mode of Birth and Related Complications among Mexican American Women

Spurlock

Kue

Gillespie

et al. 2021

J Midwife Womens Health

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Introduction Cesarean rates are particularly high among Hispanic women in some regions of the United States, placing a disproportionate health burden on women and their newborns. This integrative review synthesized the literature on mode of birth (vaginal vs cesarean) and related childbirth complications (hemorrhage, surgical site infection, perineal trauma) among Mexican American women living in the United States. Methods Four electronic databases, PubMed, Embase, CINAHL, and SCOPUS, were searched to identify studies meeting the inclusion criteria, research studies that included Mexican American women who were pregnant or postpartum. Results were limited to English language and publications that were peer‐reviewed and published before May 2020. Covidence was used in article identification, screening, and assessment. Critical appraisal of the research was performed using the Quality Assessment Tool for Studies with Diverse Designs. Results Ten articles met inclusion criteria. In some studies, Mexican American women born in the United States were more likely to have cesareans than women born in Mexico; in other studies, these findings were reversed. Mexican American women often had lower unadjusted cesarean rates compared with non‐Hispanic white women, but adjusting for birth facility (some facilities perform more cesareans than others), sociodemographic, and risk factors often revealed Mexican American women have a higher adjusted risk for cesarean birth. Women with higher socioeconomic status had higher cesarean rates compared with women with lower socioeconomic status. In studies of birth outcome by level of acculturation, women who were US‐oriented had higher rates of cesarean and more frequent perinatal complications. By ethnic subgroup, rates of cesarean and complications varied among Hispanic women. Discussion Birth facility was associated with perinatal outcomes for Mexican American women; those who gave birth at higher‐performing facilities had better outcomes when compared with women who gave birth at lower‐performing facilities. After adjusting for pregnancy complications, Mexican American women had a greater risk for cesarean birth compared with non‐Hispanic white women, a finding that may have clinical practice implications. Level of acculturation affected birth outcomes, but more research using precise instruments is needed.

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“…On the United States-Mexico border, regardless of age, Hispanic women are more likely to have cesarean birth than any other racial or ethnic group in the United States (McDonald et al, 2015(McDonald et al, , 2018. Of note, Mexico has very high cesarean rates (45.3% from 2008 to 2017), potentially influencing US cesarean rates among Mexican immigrants (Uribe- Leitz et al, 2019).…”

mentioning

confidence: 99%

Acculturation, Acculturative Stress, Experience of Discrimination, and Cesarean Birth in Mexican American Women

Spurlock

Pickler

Ruiz

et al. 2023

Hisp Health Care Int

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Introduction: There is evidence that Mexican Americans are more likely to have cesarean birth than non-Hispanic White Americans. The purpose of this study was to identify factors related to acculturation along with psychological and sociodemographic factors associated with birth mode in a prospective cohort of Mexican American women in Texas. Methods: This secondary analysis included 244 Mexican American pregnant women. Women with a prior cesarean birth were excluded. Variable selection was guided by Berry's Theoretical Framework of Acculturation. Correlations and logistic regression were used to examine relationships and predict risk of cesarean birth. Mediators and moderators were also considered. Results: Eighty women birthed by cesarean. Analytic and parent samples were similar in all demographics. After controlling for parity in logistic regression, greater Spanish language-related acculturative stress (adjusted odds ratio [AOR], 1.06, 95% confidence interval [CI] [1.01, 1.11], p = .028) and experience of discrimination (AOR, 1.18, 95% CI [1.00, 1.38], p = .044) increased the odds of cesarean birth. The relationship between acculturative stress and birth mode was moderated by birth facility. Conclusion: Acculturative stress and discrimination may play a role in birth mode for Mexican American women birthing in Texas. Birth facility and acculturative stress may be interacting in ways that have clinical significance but are yet unexplored.

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Trends in Hispanic and non-Hispanic white cesarean delivery rates on the US-Mexico border, 2000-2015

Cited by 5 publications

References 17 publications

Applying Automated Machine Learning to Predict Mode of Delivery Using Ongoing Intrapartum Data in Laboring Patients

Applying Automated Machine Learning to Predict Mode of Delivery Using Ongoing Intrapartum Data in Laboring Patients

Integrative Review of Disparities in Mode of Birth and Related Complications among Mexican American Women

Acculturation, Acculturative Stress, Experience of Discrimination, and Cesarean Birth in Mexican American Women

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