Ethnic disparity in the success of vaginal birth after cesarean delivery

Objective. To estimate whether maternal race/ethnicity is independently associated with successful vaginal birth after cesarean delivery (VBAC). Study design. A retrospective cohort study from January 1, 1997 to July 30, 2002 of women with singleton pregnancies and a previous cesarean delivery. The odds ratio ( OR) for successful VBAC as a function of ethnicity was corrected for age 435 years, parity, weight gain, diabetes mellitus, hospital site, prenatal care provider, gestational age, induction, labor augmentation, epidural analgesia, and birth weight 44000 g. Results. Among 54 146 births, 8030 (14.8%) occurred in women with previous cesarean deliveries. The trials of labor rates were similar among Caucasian (46.6%), Hispanic (45.4%), and African American (46.0%) women. However, there was a significant difference among ethnic groups for VBAC success rates (79.3% vs. 79.3% vs. 70.0%, respectively). When compared to Caucasian women, the adjusted OR for VBAC success was 0.37 (95% confidence interval (CI) 0.27-0.50) for African American women and 0.63 (95% CI 0.51-0.79) for Hispanic women. Conclusion. African American and Hispanic women are significantly less likely than Caucasian women to achieve successful VBAC.