title: Racial and Ethnic Differences in the Likelihood of Vaginal Birth After Cesarean Delivery.
abstract: BACKGROUND
  A major contributor to the increase in cesarean deliveries over recent decades is the decline in vaginal births after cesarean (VBAC). Racial and ethnic disparities in other perinatal outcomes are widely recognized, but few studies have been directed toward racial/ethnic differences in VBAC rates.
  
  
  METHODS
  We used the population-based Massachusetts Pregnancy to Early Life (PELL) database to investigate racial/ethnic differences in rates of VBAC for Massachusetts residents with one prior cesarean from 1998 to 2008.
  
  
  RESULTS
  The overall VBAC rate was 17.3 percent. After adjusting for demographic, behavioral, and medical risk factors, non-Hispanic Asian mothers had a greater likelihood of VBAC than non-Hispanic white mothers (adjusted risk ratio 1.31 [95% CI 1.23-1.39]). No other racial/ethnic group was significantly different from non-Hispanic whites in adjusted analyses. The likelihood of VBAC also decreased with increasing maternal age.
  
  
  CONCLUSIONS
  Non-Hispanic Asian women are significantly more likely to have VBAC than non-Hispanic white women. Efforts to reduce cesarean delivery rates in the United States should address these disparities. Future research should investigate factors underlying these differences to ensure that all women have access to appropriate maternity care services.
authors.affiliation: Harvard Medical School, Massachusetts General Hospital for Children, Division of General Academic Pediatrics, Boston, MA, USA.
authors.forename: Erika R
authors.initials: ER
authors.lastname: Cheng
authors.affiliation: Community Health Sciences, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Declercq
authors.affiliation: Community Health Sciences, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Candice
authors.initials: C
authors.lastname: Belanoff
authors.affiliation: Boston University School of Medicine, East Boston, MA, USA.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Iverson
authors.affiliation: Community Health Sciences, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Lois
authors.initials: L
authors.lastname: McCloskey
mesh_terms: D000328:Adult; D044466:Asian People; D002585:Cesarean Section / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008404:Massachusetts / Q000208:ethnology; D015999:Multivariate Analysis; D011247:Pregnancy; D012307:Risk Factors; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*; D044465:White People; D055815:Young Adult
keywords: cesarean delivery; delivery method; racial/ethnic disparities; vaginal birth after cesarean