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

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.