Racial/Ethnic Variations in Trial of Labor After Cesarean in an Understudied Population [37Q

Abstract

INTRODUCTION: 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 racial/ethnic differences in trial of labor after cesarean (TOLAC) and VBAC rates in a largely Asian and Pacific Islander population. METHODS: Retrospective chart review was performed on all women with a term, singleton, 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 regression was performed to examine the likelihood of a successful VBAC for twelve different races/ethnicities. RESULTS: A total of 4,517 women met study criteria. Of the 37.8% that tried labor, 80.1% had a successful VBAC resulting in an overall 30.3% VBAC rate for the population studied. Native Hawaiians and other Pacific Islander (PI) groups (Marshallese, Micronesian, Other PI) (n=1,814) had the highest TOLAC rates (37.6-78.5%). Adjusted odds of successful VBAC was similar to White women in all groups except for Marshallese and Micronesian women (aOR 4.24, 95% CI 2.02-8.90 and aOR, 3.51, 95% CI 1.83-6.76). CONCLUSION: The high VBAC rate in the population studied was largely due to a high TOLAC rate. One's race/ethnicity should not deter a patient from attempting VBAC. Further research should be performed to see if these findings can be replicated.