Women's Health Issues
Volume 16, Issue 4 , Pages 189-197, July 2006

Obstetric complications during labor and delivery: Assessing ethnic differences in California

  • Sylvia Guendelman, PhD

      Affiliations

    • Maternal and Child Health Program, School of Public Health, University of California, Berkeley, California
    • Corresponding Author InformationCorrespondence to: Sylvia Guendelman, Ph.D., Professor, Maternal and Child Health Program, School of Public Health, University of California, Berkeley, 406 Warren Hall, Berkeley, CA 94720-7360; Phone: 510-642-2848; Fax: 510-643-8236.
    • ,
  • Dorothy Thornton, PhD

      Affiliations

    • Maternal and Child Health Program, School of Public Health, University of California, Berkeley, California
    • ,
  • Jeffrey Gould, MD, MPH

      Affiliations

    • Perinatal Epidemiology and Health Outcomes Research Unit, School of Medicine, Stanford University, Palo Alto, California
    • ,
  • Nap Hosang, MD, MPH, MBA

      Affiliations

    • Department of Obstetrics, Kaiser Permanente Medical Center, Hayward, California

Received 5 July 2005; received in revised form 15 March 2006; accepted 24 March 2006.

Purpose

We sought to compare obstetric complications during labor and delivery among white non-Latina (white), black, Asian, and Latina women who delivered in California hospitals. Many intrapartum complications are preventable.

Methods

We used linked 1996–1998 state hospital discharge and birth certificate data to examine obstetric complications International Classification of Diseases, 9th Revision, Clinical Modification codes considered relevant for population surveillance. We compared the observed and adjusted odds of experiencing a complication among women of color, using white women as the reference group.

Findings

One out of 5 deliveries had ≥1 complication. White (21.3%) and Asian women (21.1%) had similar prevalence rates, whereas black women (24.2%) had higher and Latina women (19.6%) had lower rates. After adjusting for covariates, the odds of experiencing ≥1 complication was lower for Asians (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.93, 0.96) and Latinas (OR = 0.97; 95% CI = 0.96, 0.98) than whites; the odds for black women remained elevated (OR = 1.25; 95% CI = 1.23, 1.27). Asian women stood a higher risk of deliveries with major lacerations, postpartum hemorrhage, and major puerperal infections. Rates for the latter complication were higher among all women of color.

Conclusions

The burden of morbidity is high for all women, regardless of ethnicity. Yet, compared to white women, blacks suffer more aggregate morbidities, and Asians stand a high risk of all 3 intrapartum care–sensitive conditions. Furthermore, all women of color experience disproportionate rates of puerperal infections. Collective action is needed to reduce these disparities and improve maternal health.

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 Supported by the Maternal and Child Health Bureau and the Center for Health Research at the University of California, Berkeley

PII: S1049-3867(06)00055-7

doi:10.1016/j.whi.2005.12.004

Women's Health Issues
Volume 16, Issue 4 , Pages 189-197, July 2006

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