J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website https://jcgo.elmerpub.com

Original Article

Volume 14, Number 4, December 2025, pages 122-129

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

↓ **Table 1.** Descriptives Stratified by Delivery Type
Descriptives	Delivery type	P
TOLAC: trial of labor after cesarean section; VBAC: vaginal birth after cesarean section.
Deliveries, N	1,174	210	516	-
Age, mean ± SD (years)	29.84 ± 5.41	29.11 ± 5.38	29.69 ± 5.26	0.191
Gravida, mean ± SD	2.81 ± 1.27	3.14 ± 1.65	3.25 ± 1.66	< 0.001
Parity, mean ± SD	1.30 ± 2.88	1.50 ±1.09	1.69 ± 1.26	0.008
Height, mean ± SD (inches)	68.87 ± 2.89	63.37 ±2 .82	63.40 ± 3.18	0.002
Weight, mean ± SD (pounds)	177.33 ± 49.57	173.76 ± 45.79	177.23 ± 51.56	0.656
History of vaginal delivery, %	14.4	24.29	37.98	< 0.001
History of arrest, %	42.93	35.71	26.55	< 0.001
Hypertension, %	7.07	5.71	2.71	0.002
Race, %
White	72.83	51.9	63.57	< 0.001
Black	9.63	20	15.5
Asian	5.88	8.57	4.84
Other	1.36	0.95	1.16
Multiracial	1.11	0.48	0.58
Missing	9.2	18.1	14.34
Ethnicity, %
Not Hispanic/Latino	74.7	72.38	63.95	< 0.001
Hispanic/Latino	22.4	24.29	33.53
Missing	2.9	3.33	2.52

↓ Table 1. Descriptives Stratified by Delivery Type

Descriptives

Delivery type

No TOLAC

VBAC

Unsuccessful TOLAC

TOLAC: trial of labor after cesarean section; VBAC: vaginal birth after cesarean section.

Deliveries, N

1,174

210

516

Age, mean ± SD (years)

29.84 ± 5.41

29.11 ± 5.38

29.69 ± 5.26

0.191

Gravida, mean ± SD

2.81 ± 1.27

3.14 ± 1.65

3.25 ± 1.66

< 0.001

Parity, mean ± SD

1.30 ± 2.88

1.50 ±1.09

1.69 ± 1.26

0.008

Height, mean ± SD (inches)

68.87 ± 2.89

63.37 ±2 .82

63.40 ± 3.18

0.002

Weight, mean ± SD (pounds)

177.33 ± 49.57

173.76 ± 45.79

177.23 ± 51.56

0.656

History of vaginal delivery, %

14.4

24.29

37.98

< 0.001

History of arrest, %

42.93

35.71

26.55

< 0.001

Hypertension, %

7.07

5.71

2.71

0.002

Race, %

White

72.83

51.9

63.57

< 0.001

Black

9.63

15.5

Asian

5.88

8.57

4.84

Other

1.36

0.95

1.16

Multiracial

1.11

0.48

0.58

Missing

9.2

18.1

14.34

Ethnicity, %

Not Hispanic/Latino

74.7

72.38

63.95

< 0.001

Hispanic/Latino

22.4

24.29

33.53

Missing

2.9

3.33

2.52

↓ **Table 2.** Descriptives Stratified by Time Period
Descriptives	Time period	P
TOLAC: trial of labor after cesarean section; VBAC: vaginal birth after cesarean section.
Deliveries, N	769	398	733	-
Race, %
White	65.28	77.39	65.76	0.003
Black	13.65	8.79	12.96
Asian	5.33	4.77	7.09
Other	1.17	0.5	1.77
Multiracial	0.91	1.01	0.82
Missing	13.65	7.54	11.6
Ethnicity, %
Not Hispanic/Latino	74.51	71.61	68.35	0.025
Hispanic/Latino	22.11	26.63	28.79
Missing	3.38	1.76	2.86

↓ Table 2. Descriptives Stratified by Time Period

Descriptives

Time period

Time period 1

Time period 2

Time period 3

TOLAC: trial of labor after cesarean section; VBAC: vaginal birth after cesarean section.

Deliveries, N

769

398

733

Race, %

White

65.28

77.39

65.76

0.003

Black

13.65

8.79

12.96

Asian

5.33

4.77

7.09

Other

1.17

0.5

1.77

Multiracial

0.91

1.01

0.82

Missing

13.65

7.54

11.6

Ethnicity, %

Not Hispanic/Latino

74.51

71.61

68.35

0.025

Hispanic/Latino

22.11

26.63

28.79

Missing

3.38

1.76

2.86

↓ **Table 3.** Logistic Regression: Attempted TOLAC and Successful VBAC by Time Period, Race, and Ethnicity
	Attempted TOLAC	Successful VBAC^a
^aOnly patients that attempted TOLAC were included in the successful VBAC analysis. CI: confidence interval; OR: odds ratio; TOLAC: trial of labor after cesarean section; VBAC: vaginal birth after cesarean section.
Time period
1: January 2017 - January 2020	33.29	Reference	48.98	Reference
2: February 2020 - May 2021	35.43	1.1 (0.85 - 1.42), P = 0.465	62.51	1.28 (0.81 - 2.01), P = 0.292
3: June 2021 - June 2024	44.88	1.63 (1.32 - 2.01), P < 0.001	73.43	1.25 (0.88 - 1.79), P = 0.219
Race
White	33.82	Reference	75.06	Reference
Black	51.91	2.11 (1.60 - 2.80), P < 0.001	65.57	0.63 (0.41 - 0.97), P = 0.038
Asian	38.39	1.22 (0.82 - 1.82), P = 0.329	58.13	0.46 (0.24 - 0.88), P = 0.019
Ethnicity
Not Hispanic/Latino	35.47	Reference	68.46	Reference
Hispanic/Latino	46.00	1.55 (1.26 - 1.91), P < 0.001	77.23	1.56 (1.08 - 2.25), P = 0.017

↓ Table 3. Logistic Regression: Attempted TOLAC and Successful VBAC by Time Period, Race, and Ethnicity

Attempted TOLAC

Successful VBAC^a

Rate, %

OR (95% CI), P

Rate, %

OR (95% CI), P

^aOnly patients that attempted TOLAC were included in the successful VBAC analysis. CI: confidence interval; OR: odds ratio; TOLAC: trial of labor after cesarean section; VBAC: vaginal birth after cesarean section.

Time period

1: January 2017 - January 2020

33.29

Reference

48.98

Reference

2: February 2020 - May 2021

35.43

1.1 (0.85 - 1.42), P = 0.465

62.51

1.28 (0.81 - 2.01), P = 0.292

3: June 2021 - June 2024

44.88

1.63 (1.32 - 2.01), P < 0.001

73.43

1.25 (0.88 - 1.79), P = 0.219

Race

White

33.82

Reference

75.06

Reference

Black

51.91

2.11 (1.60 - 2.80), P < 0.001

65.57

0.63 (0.41 - 0.97), P = 0.038

Asian

38.39

1.22 (0.82 - 1.82), P = 0.329

58.13

0.46 (0.24 - 0.88), P = 0.019

Ethnicity

Not Hispanic/Latino

35.47

Reference

68.46

Reference

Hispanic/Latino

46.00

1.55 (1.26 - 1.91), P < 0.001

77.23

1.56 (1.08 - 2.25), P = 0.017

↓ **Table 4.** Logistic Regression: Attempted TOLAC and Successful VBAC Within Each Time Period by Race and Ethnicity
	Attempted TOLAC	Successful VBAC^a
^aOnly patients that attempted TOLAC were included in the successful VBAC analysis. CI: confidence interval; OR: odds ratio; TOLAC: trial of labor after cesarean section; VBAC: vaginal birth after cesarean section.
Time period 1: January 2017 - January 2020
Race
White	27.89	Reference	74.29	Reference
Black	46.67	2.26 (1.47 - 3.48), P = 0.001	61.22	0.55 (0.27 - 1.09), P = 0.085
Asian	26.83	0.95 (0.46 - 1.94), P = 0.884	54.55	0.42 (0.12 - 1.44), P = 0.167
Ethnicity
Not Hispanic/Latino	30.89	Reference	66.67	Reference
Hispanic/Latino	43.53	1.72 (1.21 - 2.45), P = 0.002	72.97	1.35 (0.74 - 2.46), P = 0.328
Time period 2: February 2020 - May 2021
Race
White	33.77	Reference	76.92	Reference
Black	48.57	1.85 (0.92 - 3.744), P = 0.086	76.47	0.98 (0.29 - 3.27), P = 0.967
Asian	36.84	1.14 (0.437 - 2.99), P = 0.784	42.86	0.23 (0.05 - 1.08), P = 0.062
Ethnicity
Not Hispanic/Latino	35.79	Reference	70.59	Reference
Hispanic/Latino	34.91	0.96 (0.6 - 1.53), P = 0.871	78.38	1.51 (0.62 - 3.68), P = 0.364
Time period 3: June 2021 - June 2024
Race
White	40.04	Reference	74.61	Reference
Black	58.95	2.15 (1.37 - 3.36), P = 0.001	66.07	0.66 (0.35 - 1.26), P = 0.208
Asian	48.08	1.39 (0.78 - 2.46), P = 0.264	64.00	0.60 (0.25 - 1.46), P = 0.262
Ethnicity
Not Hispanic/Latino	40.52	Reference	68.97	Reference
Hispanic/Latino	53.55	1.69 (1.22 - 2.34), P = 0.002	79.65	1.76 (1.02 - 3.04), P = 0.042

↓ Table 4. Logistic Regression: Attempted TOLAC and Successful VBAC Within Each Time Period by Race and Ethnicity

Attempted TOLAC

Successful VBAC^a

Rate, %

OR (95% CI), P

Rate, %

OR (95% CI), P

Time period 1: January 2017 - January 2020

Race

White

27.89

Reference

74.29

Reference

Black

46.67

2.26 (1.47 - 3.48), P = 0.001

61.22

0.55 (0.27 - 1.09), P = 0.085

Asian

26.83

0.95 (0.46 - 1.94), P = 0.884

54.55

0.42 (0.12 - 1.44), P = 0.167

Ethnicity

Not Hispanic/Latino

30.89

Reference

66.67

Reference

Hispanic/Latino

43.53

1.72 (1.21 - 2.45), P = 0.002

72.97

1.35 (0.74 - 2.46), P = 0.328

Time period 2: February 2020 - May 2021

Race

White

33.77

Reference

76.92

Reference

Black

48.57

1.85 (0.92 - 3.744), P = 0.086

76.47

0.98 (0.29 - 3.27), P = 0.967

Asian

36.84

1.14 (0.437 - 2.99), P = 0.784

42.86

0.23 (0.05 - 1.08), P = 0.062

Ethnicity

Not Hispanic/Latino

35.79

Reference

70.59

Reference

Hispanic/Latino

34.91

0.96 (0.6 - 1.53), P = 0.871

78.38

1.51 (0.62 - 3.68), P = 0.364

Time period 3: June 2021 - June 2024

Race

White

40.04

Reference

74.61

Reference

Black

58.95

2.15 (1.37 - 3.36), P = 0.001

66.07

0.66 (0.35 - 1.26), P = 0.208

Asian

48.08

1.39 (0.78 - 2.46), P = 0.264

64.00

0.60 (0.25 - 1.46), P = 0.262

Ethnicity

Not Hispanic/Latino

40.52

Reference

68.97

Reference

Hispanic/Latino

53.55

1.69 (1.22 - 2.34), P = 0.002

79.65

1.76 (1.02 - 3.04), P = 0.042

↓ **Table 5.** Descriptive Characteristics by Reasons for Delivery Type
Descriptives	Reason for delivery type	P
TOLAC: trial of labor after cesarean section.
Deliveries, N	1,165	5	124	66	11	511	18	-
Race, %
White	72.70	40.00	54.84	48.48	36.36	63.80	72.22	< 0.001
Black	9.61	60.00	13.71	28.79	45.45	15.07	11.11
Asian	5.92	0.00	11.29	6.06	0.00	4.89	0.00
Other	1.37	0.00	1.61	0.00	0.00	1.17	0.00
Multiracial	1.12	0.00	0.00	1.52	0.00	0.59	0.00
Missing	9.27	0.00	18.55	15.15	18.18	14.48	16.67
Ethnicity, %
Non-Hispanic/Latino	74.76	100.00	71.77	74.24	72.73	63.60	66.67	0.001
Hispanic/Latino	22.49	0.00	25.00	22.73	18.18	33.86	22.22
Missing	2.75	0.00	3.23	3.03	9.09	2.54	11.11

↓ Table 5. Descriptive Characteristics by Reasons for Delivery Type

Descriptives

Reason for delivery type

Declined TOLAC

Preference for TOLAC

Failed induction

Fetal status

Maternal status

Successful TOLAC

No reason given

TOLAC: trial of labor after cesarean section.

Deliveries, N

1,165

124

511

Race, %

White

72.70

40.00

54.84

48.48

36.36

63.80

72.22

< 0.001

Black

9.61

60.00

13.71

28.79

45.45

15.07

11.11

Asian

5.92

0.00

11.29

6.06

0.00

4.89

0.00

Other

1.37

0.00

1.61

0.00

1.17

0.00

Multiracial

1.12

0.00

1.52

0.00

0.59

0.00

Missing

9.27

0.00

18.55

15.15

18.18

14.48

16.67

Ethnicity, %

Non-Hispanic/Latino

74.76

100.00

71.77

74.24

72.73

63.60

66.67

0.001

Hispanic/Latino

22.49

0.00

25.00

22.73

18.18

33.86

22.22

Missing

2.75

0.00

3.23

3.03

9.09

2.54

11.11