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Am J Perinatol
DOI: 10.1055/a-2593-0555
Original Article

Assessing Racial/Ethnic Variation and Trends in Vaginal Birth after Cesarean in California: A Retrospective Cohort Study Using Linked Birth Certificate and Hospital Discharge Records

Nicholas Rubashkin 
1   Division of Ob/Gyn Hospital Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco School of Medicine, San Francisco, California
,
E. Nicole Teal
2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Diego School of Medicine, San Diego, California
,
Rebecca J. Baer
3   California Preterm Birth Initiative, University of California at San Francisco School of Medicine, San Francisco, California
4   Department of Pediatrics, University of California at San Diego School of Medicine, La Jolla, California
,
Saraswathi Vedam
5   Birth Place Lab, Faculty of Medicine, University of British Columbia, Vancouver, Canada
6   School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
,
Miriam Kuppermann
3   California Preterm Birth Initiative, University of California at San Francisco School of Medicine, San Francisco, California
7   Departments of Obstetrics, Gynecology and Reproductive Sciences (Division of Maternal Fetal Medicine) and Epidemiology and Biostatistics, University of California at San Francisco School of Medicine, San Francisco, California
,
Grace Lanouette
8   Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, Massachusetts
,
Laura L. Jelliffe-Pawlowski
3   California Preterm Birth Initiative, University of California at San Francisco School of Medicine, San Francisco, California
9   Department of Epidemiology and Biostatistics, University of California at San Francisco School of Medicine, San Francisco, California
10   Institute for Global Health Sciences, University of California San Francisco School of Medicine, San Francisco, California
11   Mory Meyers College of Nursing, New York University, New York, New York
,
Melissa G. Rosenstein
12   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco School of Medicine, San Francisco, California
› Institutsangaben
Funding None.
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Abstract

Objective

Increasing the vaginal birth after cesarean (VBAC) rate to 18% was a Healthy People 2020 goal. Detailed data on racial/ethnic differences in VBAC rates is lacking and can inform efforts to equitably increase VBAC rates. This study aimed to assess racial/ethnic variation in VBAC rates and to describe group trends in VBAC rates in California between 2011 and 2021.

Study Design

This retrospective cohort study used a database of birth certificates linked to hospital discharge records. We analyzed singleton, term live births among people who had a history of at least one prior cesarean birth, no identified contraindications to a vaginal birth, and self-identified their racial/ethnic group as Hispanic or non-Hispanic (American Indian-Alaskan Native (AIAN), Asian, Black, Hawaiian/Pacific Islander, or white). VBAC births were identified from birth certificate records. Differences between VBAC rates were assessed using univariable and multivariable Poisson log-linear regression while adjusting for potential confounders.

Results

A total of 607,808 birthing people were included (2,234 AIAN, 84,899 Asian, 34,217 Black, 2,559 Hawaiian/Pacific Islander, 334,116 Hispanic, 149,783 white). Over the study period, Hawaiian/Pacific Islander birthing people had the highest average VBAC rate at 11.5% (AIAN, 6.5%; Asian, 8.8%; Black, 8.0%; Hispanic, 7.4%; white, 9.5%). In adjusted models, Black (aRR = 1.06, 95% CI: 1.01–1.11) and Hawaiian/Pacific Islander (aRR = 1.43, 95% CI: 1.27–1.61) birthing people were more likely to have a VBAC compared with white birthing people, while Hispanic birthing people were less likely (aRR = 0.96, 95% CI: 0.93–0.98). VBAC rates increased significantly (p < 0.001) over time for all groups except AIAN birthing people.

Conclusion

VBAC rates increased for most racial/ethnic groups in California. With the exception of the Hawaiian/Pacific Islander group, there were small and likely not clinically significant differences in the chances for a VBAC across groups. No group in California met the Healthy People 2020 goal VBAC rate of 18%.

Key Points

  • VBAC rates increased for most racial/ethnic groups.

  • The VBAC rate for AIAN birthing people did not increase.

  • No group met the Healthy People 2020 goal VBAC rate of 18%.

Keywords

disparities - VBAC - California

Supplementary Material



Publikationsverlauf

Eingereicht: 13. März 2025

Angenommen: 22. April 2025

Artikel online veröffentlicht:
12. Mai 2025

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