228638 Vaginal birth after cesarean: Does race/ethnicity matter as rates plummet?

Monday, November 8, 2010 : 4:50 PM - 5:10 PM

Lois McCloskey, DrPH , Department of Community Health Sciences/MCH, Boston University School of Public Health, Boston, MA
Eugene Declercq, PhD , Department of Maternal and Child Health, Boston University School of Public Health, Boston, MA
Hannah Jong , Department of Community Health Sciences/MCH, Boston University School of Public Health, Boston, MA
U.S. cesarean rates rose for the 11th consecutive year in 2007, reaching 31.8% overall and 22 % for primary cesareans. With this trend comes an ever-larger and more diverse cohort of women eligible for a repeat cesarean or vaginal birth after cesarean (VBAC). In the mid 1990's over one quarter of women with a prior cesarean were able to give birth vaginally, yet by 2007, the rate plummeted to 7%. During this downward trend, little attention has been paid to how the use of VBAC's differs by women's medical and social characteristics, including her race and ethnicity. This study addresses this gap by using a Massachusetts-wide longitudinal data base that links birth certificate and hospital discharge data to explore two questions: 1) What characteristics distinguish between women who receive a VBAC vs. repeat cesarean? 2) To what extent does race/ethnicity predict the use of VBAC after taking into account other potential risk factors? Our preliminary analyses shows that race/ethnicity matters, though with decreasing importance as rates plummet. Asian and Pacific Islanders are most likely to have a VBAC, and white women, least likely. As expected, other predictors of VBAC include lower medical risk, younger age, and higher presence of midwives in the hospital. This paper will report on findings of our multivariate analyses to determine whether racial disparities persist after adjusting for other social and medical risks. Our's is the first known study to examine racial disparities in VBAC use in a state-wide population sample.

Learning Areas:
Provision of health care to the public
Public health or related research
Social and behavioral sciences

Learning Objectives:
Participants in this session will be able to: 1. Describe the trends in VBAC rates from the 1980ís through the present; 2. Describe the variation in VBAC use by demographic, social and medical risk characteristics; and 3. Describe the trend in the relative importance of patient race/ethnicity as a factor associated with the use of VBAC in the context of rapidly declining access overall.

Keywords: Access, Maternal Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Lois McCloskey possesses over 25 years of experience in domestic and international health. Her public health career began as an applied anthropologist and educator of community health workers in Nepal. In 1989, Dr. McCloskey co-founded the Institute for Urban Health Policy and Research for the Boston Department of Health and Hospitals and served as its Senior Research Scientist for 7 years before joining the faculty of Boston University where she remains today as an Associate Professor in Community Health Sciences . Dr. McCloskey's research activities focus on race-based disparities in infant mortality and pre-term birth, access to and quality of prenatal and primary health care for women in low-income communities, provider-patient communication, and the evaluation of community-based urban health initiatives.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.