Why Black women are more likely to have unnecessary C-sections

Learn about the possible risks, plus how to speak up for a safe, healthy birth — for you and your baby.

Sometimes, having your baby by cesarean delivery, or C-section, is safer than a vaginal birth. It may even save your life or the life of your child. A C-section is an operation where the doctor takes the baby out through a cut in your abdominal wall. You might need an emergency C-section if there’s a problem during labor that puts you or your baby at risk. 

But experts say that doctors do way too many of these procedures — especially for Black women. In 2024, researchers found that Black mothers are 25% more likely than white mothers to have an unplanned C-section. 

C-sections are super common. But they can sometimes lead to problems for mothers and their babies, says Ndidiamaka Amutah-Onukagha, PhD, MPH. She is the director of the Center for Black Maternal Health and Reproductive Justice at Tufts University in Boston. 

C-sections can cause serious health risks for the mother. These include: 

C-sections may also cause breathing problems in babies. And they can make it harder to breastfeed your baby, says Amutah-Onukagha. “That’s because it may keep you from starting to nurse your baby right away,” she explains. “You might still have pain from the surgery.” 

There could be lots of reasons. These are a few. 

Racial bias. When you’re in labor, your baby’s heartbeat is tracked on a fetal monitor. This helps doctors know if babies are in distress and helps them decide whether moms need emergency C-sections.  

But research suggests doctors often interpret fetal monitor readings differently for Black women. They may not even be aware that they are doing it. (This is called implicit racial bias.) 

One study looked at the records of more than 16,000 women. The women all had the same health insurance plan. They also used the same network of doctors and hospitals.  

What did the study show? Doctors rushed Black moms into the operating room for emergency C-sections much more often than other moms. This suggests that implicit bias can play a role in making the decision and lead to unnecessary surgeries. 

Financial incentive. Hospitals are paid more for a C-section than for a vaginal birth. In 2024, researchers looked at the records of nearly a million moms. Here’s what they found: Doctors ordered more unplanned C-sections when there was an open operating room in the maternity ward. This was true for all patients in labor. But it happened most often when the patients were Black. 

Chronic health problems. “Conditions like obesity, diabetes, or high blood pressure can play a part, too,” says Amutah-Onukagha. Black people have higher rates of these conditions than other groups. That can lead to a much higher chance of needing a C-section.  

Pushback from doctors. More than 40% of Black women say they’ve faced discrimination during their maternity care. For example, during childbirth, doctors may not take their concerns seriously. Research also shows that Black patients are more likely to report they felt pressure to have a C-section than other patients. 

[Subhead] Here’s how to take control. 

Maybe a C-section will be the best choice for you. But maybe it won’t. So be prepared for the option to come up during delivery. And don’t be afraid to bring it up with your doctor during your prenatal visits. To avoid a C-section you may not need, try these tips. 

Find the right provider. “You need to feel safe and listened to. Starting at your very first appointment,” says Amutah-Onukagha. “If you don’t, find another doctor.” One trait to think about looking for? A provider who is the same race as you. Some research shows that it is linked to a better birth experience. 

Speak up. If something doesn’t feel right, say so. Your doctor and nurses are experts in medicine. But the best expert on your own body is you. Don’t be afraid to ask questions. And expect to get answers. 

Find an advocate. Bring a trusted friend or family member to your appointments. And to the labor and delivery room, too. Or use a doula. That’s someone trained to give you support during pregnancy, labor, and delivery. 

“Doulas provide a buffer against racism in health care for Black pregnant women,” says Amutah-Onukagha. “They speak up for the mom to the doctors and nurses. Studies show that doula support leads to lower rates of C-sections.” (Some insurance plans cover doula services and others do not. Check with your plan to find out if you’re covered.) 

Learn as much as you can. Sign up for a childbirth class. “Moms can empower themselves by learning about their risks,” says Amutah-Onukagha. Another tip? Learn where to go for the care services you need. 

Make a birth plan. This is a written outline that lets your delivery team know ahead of time what you want during labor and delivery. You can include things like the position you want to give birth in and the kind of pain relief you want. You can also say which people you want to be with you, such as your partner or a family member.  

A recent study found that women with a birth plan had much fewer C-sections than women who didn’t have a plan.  

Expect the unexpected. Even if you have a detailed birth plan, things may not go the way you want. Unexpected things can happen during childbirth. Try to stay calm. Don’t forget to lean on your advocate.  

And if things don’t go as planned, remember: What matters most is that you and your baby have a safe delivery. directly. They can tell you if you need to call your doctor right away, or even head to the emergency room.  

Sources: 

[1] “Having a C-section.” March of Dimes, November 2024, https://www.marchofdimes.org/find-support/topics/birth/having-c-section 

[2] Corredor-Waldron, Currie et al. “Drivers of Racial Differences in C-Sections.”  Northwestern University Institute for Policy Research, September 16, 2024. https://www.ipr.northwestern.edu/our-work/working-papers/2024/wp-24-24.html 

[3] Okwandu IC, Anderson M, et al. “Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women.” Journal of Racial and Ethnic Health Disparities August 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9249704/ 

[4] “Key Data on Health and Health Care by Race and Ethnicity.” Kaiser Family Foundation, June 11, 2024. https://www.kff.org/key-data-on-health-and-health-care-by-race-and-ethnicity/?entry=executive-summary-introduction. 

[5] Fresch R, Stephens K, DeFranco E. “The Combined Influence of Maternal Medical Conditions on the Risk of Primary Cesarean Delivery.” 

AJP Reports January 23, 2024. https://pubmed.ncbi.nlm.nih.gov/38269123/ 

[6] Cheng ER, Carroll AE, et al. “Communications Between Pregnant Women and Maternity Care Clinicians.” JAMA Network Open, May 1, 2020. 

[7] Teal EN, Daye A, et al. “Exploring Black Birthing People’s Perspectives on Racial Concordance with Obstetric Care Providers.” American Journal of Obstetrics & Gynecology, January 2024. https://www.ajog.org/article/S0002-9378(23)00887-6/fulltext