Obstetric complications during labor and delivery: assessing ethnic differences in California.
OBJECTIVE
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.


RESULTS
One out of 5 deliveries had >or=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 >or=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.
Guendelman
Sylvia
S
Maternal and Child Health Program, School of Public Health, University of California, Berkeley, 94720-7360, USA. sylviag@berkeley.edu
Thornton
Dorothy
D
Gould
Jeffrey
J
Hosang
Nap
N
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001213:Asian / Q000706:statistics & numerical data*; D002140:California / Q000453:epidemiology; D016001:Confidence Intervals; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008429:Maternal Welfare / Q000208:ethnology / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000208:ethnology; D016017:Odds Ratio; D011247:Pregnancy; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data*