Who Is Harmed When Labor Floors Are Busy? A Racial Disparities Analysis [27T

Abstract

INTRODUCTION: Busyness on labor and delivery floors is associated with higher odds of interventions and adverse maternal outcomes. Other studies suggest that providers' implicit biases are activated during busy times. We test the hypothesis that the “busyness effect” is more pronounced for black women than for white women. METHODS: We ran race-stratified logistic regressions to estimate whether delivering at busier times was associated with higher odds of birth interventions or adverse outcomes for the mother or neonate, controlling for hospital and other factors. The data included linked birth certificate and claims data for all births at 21 hospitals in Philadelphia from 1996-2010 (n=290,169 births). RESULTS: Within a hospital, delivering at a busy time is associated with increased odds of interventions for both white women (OR=1.08, 95% CI (1.03,1.14)) and black women (OR=1.07, 95% CI (1.04,1.12)); however, it is only associated with increased odds of adverse maternal outcomes for black women (OR=1.06, 95% CI (1.02,1.10)), not for white women (OR=1.01, 95% CI (0.96,1.06)). Busyness is not associated with adverse outcomes for neonates. These results hold after excluding hospitals with racially homogenous patient populations. CONCLUSION: Busyness on labor and delivery floors is associated with increased odds of adverse maternal outcomes for black women, but not for white women, which could contribute to racial disparities in maternal outcomes. Further research is needed to better understand this association.