title: Ethnic disparities in repeat caesarean rates at Auckland Hospital.
abstract: BACKGROUND
  New Zealand guidelines recommend that information regarding childbirth choices be given to women with previous caesarean, so they can make informed decisions about their care. We hypothesised that rates of trial of labour (TOL) and vaginal birth after caesarean (VBAC) would vary by women's ethnicity.
  
  
  OBJECTIVE
  To estimate the association of ethnicity with TOL and VBAC rates.
  
  
  METHODS
  Clinical data were used to identify women who gave birth at Auckland Hospital in 2006-2009 with history of previous caesarean eligible for TOL. Multivariable models were used to estimate the association of women's characteristics (ethnicity, age, socio-economic status (SES), height, body mass index, lead maternity carer, diabetes, hypertension, haemorrhage, labour induction, gestational age) with rates of TOL and VBAC.
  
  
  RESULTS
  In the study cohort of 2400 women, the TOL rate was 39.5%; the VBAC rate was 57.4%. Pacific women were twice as likely to have TOL, while Asian and non-New Zealand European women were half as likely to have VBAC, compared with New Zealand European women. Women in more deprived areas were more likely to have TOL, but SES was not associated with VBAC rates. Women under the care of private obstetricians were least likely to have TOL or VBAC.
  
  
  CONCLUSIONS
  There are ethnic disparities in TOL and VBAC rates at our hospital. Strategies need to be developed to ensure that women of all ethnicities have access to both options for mode of delivery.
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Wise
authors.forename: Ngaire H
authors.initials: NH
authors.lastname: Anderson
authors.forename: Lynn
authors.initials: L
authors.lastname: Sadler
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D009520:New Zealand; D011204:Poverty Areas; D011247:Pregnancy; D012189:Retrospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: caesarean section; ethnic groups; repeat; risk factors; trial of labour; vaginal birth after caesarean