Parents who live in certain parts of Arkansas are more likely to give birth through cesarean section, or C-section, than birth-givers in other parts of the state, according to an analysis by the Arkansas Center for Health Improvement (ACHI).
The analysis is a contribution to ACHI’s “Birthing Journey” project. The project seeks to raise awareness, promote discussion and inform health care providers, stakeholders and policymakers as they address Arkansas’ maternal mortality rate which is the highest in the nation.
“We put up Birthing Journey to talk about the entire pathway of having a baby in Arkansas and we’re looking at each step along that path for opportunities to improve the health and the outcomes in both moms and their babies,” said president and CEO Dr. Joseph Thompson.
Both maternal mortality and infant mortality are detrimental to Arkansans.
“(Nov. 1) the National Center for Health Statistics announced for the first time in over two decades infant mortality has gone up in the United States by 3% and unfortunately Arkansas continues to be at the top of that list of states that has a high problem with infant mortality,” he said.
The Centers for Disease Control and Prevention reports that in 2022 Arkansas suffered 40.4 maternal deaths per 100,000 live births. The national average is 32.9.
This is due to having risks of complications such as infection, blood loss, blood clots and injury to organs. For most pregnancies a vaginal delivery is safer.
ACHI also examined C-section rates among first-birth patients, for purposes of the analysis defined as women giving birth for the first time with full-term pregnancies and only a single baby in a head-down position.
The five highest counties with C-section rates for first-birth deliveries were Desha, Ashley, Chicot, Drew, and Stone. The five counties with the lowest rates were Woodruff, Searcy, Johnson, Marion and Boone. The placement of maternity health care near these counties greatly affects the likelihood of having a C-section birth.
“We have 75 counties in the state. A majority of those do not have a hospital that actually provides obstetric care or gives birth. So women from those counties have to travel sometimes large distances… as much as a hundred miles to get obstetrical care,” Thompson said.
Statewide C-section rates for first-birth deliveries disproportionately affect people of color. Statistics show 32.5% for Black mothers and 36.6% for Native American or Alaskan Native mothers, compared to 26.7% for white mothers.
“One of the things that leads to maternal mortality and some of the disparities that we see with women of color having higher maternal mortality and also C-section rates is how healthy they were when they became pregnant, the risks that they came in with,” Thompson said. “We know obesity rates, diabetes rates, hypertension rates are much higher in the African American community than the Caucasian community. When those women get pregnant, they carry those risks into their pregnancy and those risks subsequently may make it a high risk pregnancy that leads to a C-section appropriately.”
A federal initiative is identifying public health priorities and setting a national target of reducing the C-section rate to combat the high rate of maternal deaths.
“This is a long journey, all of which contribute to our poor health statistics and we’re trying to shine a light on each step along that pathway,” Thompson said.
You can find more about the Birthing Journey project on ACHI’s website.