Ethnic Variations in Trial of Labor after Cesarean in an Understudied Asian and Pacific Islander Population

Abstract

Background: Increasing the vaginal birth after cesarean (VBAC) rate for appropriate candidates would help to decrease the high cesarean delivery rate in the United States. The purpose of this study is to examine ethnic differences in trial of labor after cesarean (TOLAC) and VBAC rates in a largely understudied Asian and Pacific Islander (PI) population. Methods: Retrospective chart review was performed on all women with a term, singleton, and live, cephalic fetus and with a history of 1 or 2 prior cesarean deliveries who delivered at a single institution in Honolulu, Hawaii between the years 2010 and 2016. Multiple logistic regressions were performed to examine the likelihood of a successful VBAC for twelve different ethnicities. Results: A total of 4,517 women met study criteria. Of the 37.8% that attempted labor, 80.1% had a successful VBAC, resulting in an overall 30.3% VBAC rate for the population studied. Native Hawaiians and other PI groups (Marshallese, other Micronesian, other PI) (n=1,814) had the highest TOLAC rates (37.6-78.5%). Adjusted odds of successful VBAC were similar to non-Hispanic Whites in all groups except for Marshallese and other Micronesians (aOR 4.24, 95% CI 2.02-8.90 and aOR, 3.51, 95% CI 1.83-6.76, respectively). Conclusions: The high VBAC rate in the population studied was largely due to a high TOLAC rate. A woman’s ethnicity should not be deterrence from attempting VBAC. Further research should be performed to see if these findings can be replicated.