Hospital quality, processes of care, and racial disparities in birth mode for individuals with a prior cesarean

项目总结 解决黑人妇女严重孕产妇发病率居高不下的问题是一个紧迫的公众问题 健康优先。在美国每年380万新生儿中，近三分之一是通过剖腹产出生的，这是一种 严重孕产妇发病率的危险因素，黑人妇女的剖腹产率高于 白人女性。对于前次剖腹产后分娩的妇女来说，阴道分娩的产妇发病率最低， 但计划外(与计划内)重复剖腹产的比例更高。在出生方面存在种族和民族差异 有过剖腹产经历的女性中的模式，黑人女性更有可能进行计划外再次剖腹产 与白人女性相比，但人们对这些差异知之甚少。最常见的指征是 初次剖宫产是主观的，而且不同种族的剖腹产--这表明在护理质量和 按种族进行护理的过程--但对非计划性剖腹产的指征知之甚少 剖腹产后分娩。先前的研究也证实，医院的特点与住院率有关 剖宫产后产程的利用和剖宫产后阴道分娩的成功率，并有实质性的 产妇发病率在医院一级的差异以及产妇发病率的种族和族裔差异。 然而，目前尚不清楚医院的特点和护理质量如何导致出生方面的种族差异。 有过剖腹产经历的妇女中的模式，以及有过剖腹产经历的黑人妇女如何看待她们的护理。 这项混合方法的研究将使用联合的生命统计数据和出院数据，以及来自 对有剖腹产经历的黑人妇女进行有组织的采访。具体目标是：1)描述 既往有生育史妇女的医院特征与分娩方式种族差异的关系 2)探讨有剖腹产经历的黑人妇女的围产期护理经验。 尽管有过剖腹产经历的黑人(与白人)女性意外剖腹产的风险更高， 对于为什么会发生这种情况，人们知之甚少。确定促成这些结果的因素和过程是 鉴于在严重孕产妇发病率方面持续存在的种族差距，这一问题尤为紧迫。这项研究的结果将 有助于更好地了解剖宫产结束后的分娩情况 剖腹产，并帮助确定潜在的干预措施，以提高妇女的护理质量 做过剖腹产手术。

PROJECT SUMMARY Addressing the persistently high rates of severe maternal morbidity among Black women is an urgent public health priority. Of the 3.8 million U.S. births each year, nearly a third occur via cesarean delivery, which is a risk factor for severe maternal morbidity, and cesarean rates are higher among Black women than among White women. For women giving birth after a prior cesarean, maternal morbidity is lowest with a vaginal birth, but higher with an unplanned (vs. planned) repeat cesarean. There are racial and ethnic disparities in birth mode among women with a prior cesarean, with Black women more likely to have unplanned repeat cesareans compared to White women, but these disparities are poorly understood. The most common indications for primary cesarean are subjective and differ by race – suggesting potential differences in care quality and processes of care by race – but little is known about indications for unplanned cesarean among women with labor after cesarean. Prior work has also established that hospital characteristics are related to hospital rates of labor after cesarean utilization and vaginal birth after cesarean success, and that there is substantial hospital-level variation in maternal morbidity rates and racial and ethnic disparities in maternal morbidity rates. However, it is unclear how hospital characteristics and quality of care contribute to racial disparities in birth mode among women with a prior cesarean, and how Black women with a prior cesarean perceive their care. This mixed-methods study will use combined vital statistics and hospital discharge data and data from semi- structured interviews with Black women with a prior cesarean. The specific aims are: 1) To characterize the association between hospital characteristics and racial disparities in birth mode among women with a prior cesarean; and 2) To explore the experiences of perinatal care among Black women with a prior cesarean. Despite the higher risk of unplanned cesarean birth among Black (vs. White) women with a prior cesarean, little is known about why this occurs. Identifying factors and processes that contribute to these outcomes is particularly urgent given persistent racial disparities in severe maternal morbidity. Results from this study will contribute to a better understanding of the circumstances associated with labor after cesarean ending in cesarean delivery, and help to identify potential interventions to improve the quality of care for women with a prior cesarean.