Racial Disparity in the Success and Complications of Vaginal Birth After Cesarean Delivery

Cahill, Alison G. MD1; Stamilio, David M. MD, MSCE1; Odibo, Anthony O. MD, MSCE1; Peipert, Jeffery MD, MPH1; Stevens, Erika MA1; Macones, George A. MD, MSCE1

doi: 10.1097/AOG.0b013e318163be22
Original Research

OBJECTIVE: To determine if race is associated with election to attempt vaginal birth after cesarean delivery (VBAC), VBAC success, and maternal morbidities associated with VBAC.

METHODS: A retrospective, multi-center cohort study was conducted of women with a history of at least one prior cesarean delivery. Data were obtained on maternal demographics, medical history, antepartum and intrapartum course, delivery mode, and maternal outcomes. This analysis examines the association between race and the choice to have VBAC and compares the rates of VBAC success and maternal morbidity, including uterine rupture, and a composite morbidity outcome (uterine rupture, bladder and bowel injury, and artery laceration) across race groups. Race was determined by patient self-report. Univariable and multivariable analyses were performed to assess the independent association of race and clinical outcomes.

RESULTS: The cohort included 25,005 patients with at least one prior cesarean delivery. In unadjusted and multivariable analysis, black patients were more likely to undertake a trial of labor than patients of other races, and slightly more likely to experience a failure of VBAC attempt. However, black women who attempt VBAC are 40% less likely to sustain a uterine rupture (0.6% compared with 1.1%) than other racial groups, even after adjusting for relevant potentially confounding variables.

CONCLUSION: Despite increased rates of VBAC attempt and VBAC failure among black women as compared with other racial groups, black women are significantly less likely to experience a uterine rupture. It is unclear whether this discrepancy in magnitudes of risks and benefits across race associated with VBAC trials is attributable to selection bias or inherent racial differences.

LEVEL OF EVIDENCE: II

Uterine rupture is less likely among black women who attempt vaginal birth after cesarean delivery.

From the 1Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.

This work was supported by a grant from National Institute of Child Health and Human Development (NICHD) (RO1 HD 35631; to G.A.M.).

Dr. Macones is a recipient of a K24 grant from NICHD (K24 HD01289), which partially supports this work. Dr. Peipert is a recipient of a K24 grant from NICHD (K24 HD01298) which partially supports this work.

Presented at the Annual Meeting of the Society for Gynecologic Investigation, March 15, 2007, Reno, Nevada.

Corresponding author: Alison G. Cahill, MD, Division of Maternal–Fetal Medicine, Washington University School of Medicine, St. Louis, Missouri; e-mail: cahilla@wustl.edu.

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2008 The American College of Obstetricians and Gynecologists