1165 How does VBAC success rates vary by race/ethnicity?

Abstract

To examine the association between race/ethnicity and successful vaginal birth after cesarean (VBAC). This is a retrospective cohort study of women with singleton non-anomalous pregnancies between 2007 and 2011 using linked vital statistics and discharge data. Chi-square tests were used to compare rates Trial of Labor After Cesarean (TOLAC) to repeat Cesarean Delivery (CD) of women who had a previous CD as well as rates of successful VBAC from women who underwent TOLAC categorized by race. A multivariable regression was also conducted to control for several factors including race to analyze successful vaginal delivery rates. Race was categorized into six categories consisting of White (Non-Hispanic), Black (Non-Hispanic), Hispanic, Asian (Non-Hispanic), American Native (Non-Hispanic), and Other (Non-Hispanic). The cohort consisted of 343,410 pregnancies with a prior CD, 49,100 pregnancies (14.30%) resulted in TOLAC. Patients identifying as Hispanic had the lowest rate of women undergoing TOLAC (13.33%). Women who identified as Asian had the highest rate of women undergoing TOLAC (16.82%). Of the pregnancies that underwent TOLAC, 35,147 pregnancies (71.58%) resulted in a successful VBAC. Patients identifying as American Native had the lowest rate of successful VBAC (56.21%). Patients identifying as Black (Non-Hispanic) had the highest rate of successful VBAC (72.40%). While many of the proportions of successful VBAC were similar, when controlling for race a statistically significant increase was seen in rates of VBAC in Black women as well as a statistically significant decrease in rates of VBAC in American Native women. Hispanic women had the lowest rate of women undergoing TOLAC and American Native women had the lowest rate of a successful VBAC after TOLAC. Black women had marginally higher rates of successful VBAC, however, when controlling for confounders there was actually a 23% increase in successful VBAC.View Large Image Figure ViewerDownload Hi-res image Download (PPT)