Primary Submission Category: Reproductive health
Racial disparities in birth outcomes by planned place of birth in Louisiana (2012-2023)
Authors: Dovile Vilda, Inngide Osirus,
Presenting Author: Dovile VILDA*
BACKGROUND: Planned out-of-hospital births are associated with fewer medical interventions, yet little is known about variations across racial groups. Our objective was to compare birth outcomes among planned in-hospital and out-of-hospital births (or community births, i.e., occurring at home or free-standing birth centers) in Louisiana, overall and among non-Hispanic (NH) Black and White individuals.
METHODS: We conducted a retrospective cohort study of all full-term, singleton live births in Louisiana from 2012–2023 (N=731,335). Outcomes included labor induction, spontaneous labor, Cesarean delivery, NICU admission, and low birthweight. We estimated risk ratios (RRs) comparing these outcomes by planned place of birth (planned in-hospital and out-of-hospital births) using modified Poisson regression and adjusting for sociodemographic characteristics, pre-existing health conditions, and other risk factors.
RESULTS: Among 626,909 births, 99.7% were planned in-hospital and 0.3% out-of-hospital births. In fully adjusted analyses, planned in-hospital births had higher risks of labor induction (aRR = 16.20, 95% CI 11.18-23.46) and Cesarean delivery (aRR = 20.04, 95% CI 13.06-30.74) compared to planned out-of-hospital births. Black birthing individuals had the highest relative risk of Cesarean delivery in in-hospital births compared to out-of-hospital births (aRR = 27.43, 95% CI 10.29-73.09), exceeding that of White birthing individuals (aRR = 18.14, 95% CI 10.93-30.10). Additionally, spontaneous labor showed opposite trends: planned in-hospital births were associated with higher rates of spontaneous labor for White individuals (aRR = 1.43, 95% CI 1.19-1.72) but lower rates for Black individuals (aRR = 0.69, 95% CI 0.57-0.83). These patterns remained when the analysis was restricted to nulliparous pregnancies.
CONCLUSION: Our findings highlight racial disparities in birth outcomes by planned birth settings, suggesting potential differences in labor management and intervention practices by race.