Racial and Ethnic Differences in Trial of Labor After Cesarean Attempts and Vaginal Birth After Cesarean Success Rates: A Retrospective Single-Health System Study

Abstract

Background: Despite risks associated with repeat cesareans, only 14% of deliveries in the United States were vaginal births after cesareans (VBACs) in 2023. Current research demonstrates that women from minority groups are less likely to be offered a trial of labor after cesarean (TOLAC). The purpose of this study was to determine whether removal of race/ethnicity distinctions from the Maternal-Fetal Medicine Units (MFMU) Network’s VBAC calculator in 2021 resulted in a more equitable distribution of TOLAC and higher VBAC rates.

Methods: Retrospective data of patients with a previous cesarean delivery were gathered from January 2017 to June 2024, which was then analyzed utilizing Chi-squared tests and logistic regression models.

Results: Overall, 1,905 births were included, of which, 25.62% of patients identified as Hispanic and 12.65% identified as Black. Successful VBAC occurred in 516 (27.09%) births, and 1,389 deliveries were repeat cesareans (72.91%). Importantly, TOLAC rates increased after MFMU’s calculator changes. However, Black patients still had lower odds of VBAC compared to White patients after the calculator change. When evaluating reasons listed as to why patients had a failed TOLAC, it was more often attributed to maternal status for Black patients than White patients.

Conclusions: Although changes in MFMU’s VBAC calculator are correlated with increased attempted TOLAC in both Black and Hispanic patients, racial disparities in rates of successful VBAC persist.