Study links clinicians’ biased language to birth outcomes  

New Columbia Nursing research published in Health Equity has found stigmatizing language in patient electronic health records is associated with worse outcomes for birthing patients. 

Complications including delivering by cesarean despite being at low risk, postpartum hemorrhage, and chorioamnionitis (inflammation of the fetal membranes and amniotic fluid, usually due to bacterial infection) occurred more often among patients whose clinician notes revealed biased language, Assistant Professor Veronica Barcelona, PhD, and her colleagues found, with increased risks ranging from 23% to 60%. 

Previous research by Barcelona and her colleagues showed that stigmatizing language—for example, suggesting a patient is “difficult”—was present in clinician notes in labor and delivery settings.  

In the current study, they analyzed electronic health records for 18,897 patients admitted to two U.S. hospitals in 2017-2019. They found that stigmatizing language representing “difficult patients” and unilateral/authoritarian clinician decisions categories were associated with an increased likelihood of the complications under study. 

“These findings highlight the need to improve perinatal health through examining individual behaviors and structural-level policies that reinforce bias,” the authors conclude. 

The study was published online September 25, 2025. 

Barcelona’s Columbia University co-authors include postdoctoral research scientist Sarah Harkins and Associate Professor Maxim Topaz, PhD. Columbia University Data Science Institute Seed Funds and the Gordon and Betty Moore Foundation supported the research.