Table 4.

Crude and adjusted odds of NTSV cesarean birth (CD) indication using vaginal birth as the outcome referent, comparing Black gravidas in hospitals that met the Healthy People 2020 target rate of 23.9% for Black gravidas to those in hospitals that did not meet the target^*

	Hospital Group
	Met Target for Black	NOT Meet Target for Black Gravidas	Odds Ratios of CD by indication
Number of NTSV Black gravidas	3,990	16,399
NTSV CD indications	N (% CD)	N (%CD)	cOR† (95% CI)	aOR† (95% CI)
Labor Dystocia (Spontaneous labor)	175 (4.4)	999 (6.1)	1.54 (1.31, 1.82)	1.62 (1.34, 1.96)
Labor Dystocia (Induced labor)	242 (6.1)	1,251 (7.6)	1.40 (1.21, 1.61)	1.36 (1.15, 1.63)
Fetal Concern (Spontaneous labor)	197 (4.9)	1,180 (7.2)	1.62 (1.39, 1.89)	1.70 (1.42, 2.04)
Fetal Concern (Induced labor)	140 (3.5)	596 (3.6)	1.15 (0.95, 1.39)	1.13 (0.90, 1.42)
No labor (e.g. macrosomia)	76 (1.9)	627 (3.8)	2.23 (1.75, 2.84)	2.32 (1.76, 3.07)
Other indications (e.g. abruption)	26 (0.7)	157 (1.0)	1.63 (1.08, 2.48)	1.44 (0.89, 2.34)

^*Analysis restricted to 135 hospitals with at least 30 NTSV births among both Black and white gravidas.

^†Crude and adjusted OR and 95% CI estimated from multinomial logistic regression model. Adjusted model included the following factors: 1) Individual-level maternal demographic and clinical factors: age at delivery, pre-pregnancy BMI, education levels, insurance, prenatal care onset, and presence of comorbidities including preeclampsia or chronic hypertension, and preexisting or gestational diabetes; and 2) Hospital-level characteristics: >20% of vaginal births attended by CNM, hospital ownership, average annual delivery volume, and AAP NICU level.