INTRODUCTION: Racial disparities in cesarean delivery (CD) are well documented, but Native Hawaiians or Pacific Islanders (NHPI) and American Indians or Alaska Natives (AIAN) are underrepresented in literature. We aim to elucidate racial disparities in CD outcomes, focusing on NHPI and AIAN populations. METHODS: The National Surgical Quality Improvement Program was queried to identify CD outcomes from 2019 to 2020 in the National Surgical Quality Improvement Project (n=25,649). Multivariable logistic regression models were used to investigate the association of race and ethnicity on major and minor postoperative complications and reoperation. RESULTS: Racial minority groups were compared to non-Hispanic White people and adjusted for confounders. The NHPI patients had the highest risk of complication, at 4.6% greater risk of any postoperative complication (adjusted odds ratio [AOR] 1.046 [1.001–1.093]) and 3.2% greater risk of major complication (AOR 1.032 [1.006–1.058]). This was compared to a 3.2%, 1.9%, and 1.8% greater risk for any postoperative complication in Asian, Black, and Hispanic/Latina patients, respectively. The AIAN patients had the highest risk of reoperation of all groups, at 2.6% greater risk of reoperation (AOR 1.026 [1.015–1.037]). CONCLUSION: Across all groups undergoing CD, NHPI patients had the greatest risk of any postoperative complication, and AIAN patients had the greatest risk of reoperation. Our findings emphasize the need to further investigate these underrepresented minority groups in future obstetric research.