Ethnic disparity in the success of vaginal birth after cesarean delivery.
OBJECTIVE
To estimate whether maternal race/ethnicity is independently associated with successful vaginal birth after cesarean delivery (VBAC).


METHODS
A retrospective cohort study from January 1, 1997 to July 30, 2002 of women with singleton pregnancies and a previous cesarean delivery. The odds ratio (OR) for successful VBAC as a function of ethnicity was corrected for age >35 years, parity, weight gain, diabetes mellitus, hospital site, prenatal care provider, gestational age, induction, labor augmentation, epidural analgesia, and birth weight >4000 g.


RESULTS
Among 54 146 births, 8030 (14.8%) occurred in women with previous cesarean deliveries. The trials of labor rates were similar among Caucasian (46.6%), Hispanic (45.4%), and African American (46.0%) women. However, there was a significant difference among ethnic groups for VBAC success rates (79.3% vs. 79.3% vs. 70.0%, respectively). When compared to Caucasian women, the adjusted OR for VBAC success was 0.37 (95% confidence interval (CI) 0.27-0.50) for African American women and 0.63 (95% CI 0.51-0.79) for Hispanic women.


CONCLUSIONS
African American and Hispanic women are significantly less likely than Caucasian women to achieve successful VBAC.
Hollard
Amie L
AL
Division of Maternal-Fetal Medicine, Women's Hospital, Long Beach Memorial Medical Center, Long Beach, CA, USA.
Wing
Deborah A
DA
Chung
Judith H
JH
Rumney
Pamela J
PJ
Saul
Lisa
L
Nageotte
Michael P
MP
Lagrew
David
D
D000328:Adult; D001741:Black or African American; D001724:Birth Weight; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology; D012189:Retrospective Studies; D012307:Risk Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000208:ethnology / Q000209:etiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects; D044465:White People