Birth Mode after Primary Cesarean among Hispanic and non-Hispanic Women at One U.S. Institution

Abstract

Background: Despite a lower percentage of primary cesareans than non-Hispanic White and Black women, Hispanic women in the United States had the highest rate of repeat cesarean deliveries (RCD) in 2016; it is unclear if reasons for differences are due to known risk factors. Our study examined the association between ethnicity/race and RCD among women with one previous cesarean and whether demographic (age, marital status, education, language, and delivery year), anthropomorphic (height, prepregnancy body mass index), obstetrical/medical (parity, gestational age, infant birth weight, gestational diabetes, labor induction or augmentation, vaginal birth after cesarean delivery history), or health system (delivery day/time, payer source, provider gender) factors accounted for any observed differences by ethnicity/race. Methods: Our retrospective cohort study used logistic regression to evaluate the relationship between ethnicity/race and RCD based on data from electronic delivery and prenatal records from 2010 to 2016, including 1800 births to Hispanic and non-Hispanic women with one previous cesarean at a District of Columbia hospital. Results: Statistically significant differences by ethnicity/race were noted after adjustment for obstetric/medical factors, particularly parity and use of induction or augmentation methods. Hispanic (adjusted odds ratio, 2.48; 95% confidence interval, 1.03-6.01) and Black women (adjusted odds ratio, 2.83; 95% confidence interval, 1.67-4.81) had higher odds of RCD than White women. Conclusions: Adjustment for parity and use of induction or augmentation methods revealed higher odds of RCD for Hispanic and Black women than White women. Demographic and anthropometric factors did not alter these results. Our work is a first step in creating effective public health policy and programs that target potentially preventable RCD by highlighting the need to evaluate risk factors beyond those included in the literature to date.

Maternal and fetal characteristics for predicting risk of Cesarean section following induction of labor: pooled analysis of PROBAAT trials

“…Biological differences in pelvic architecture and connective tissue, labor prolongation and the likelihood of fetal compromise between ethnic groups have been proposed to explain these findings 26 . Provider bias, manifested as variation in labor practices depending on race, has also been suggested to be a contributing factor 27 . In this analysis, we provided additional insights into other ethnic groups (South Asian, Sub-Saharan and Mediterranean) living outside the USA.…”

“…Most studies focusing on the association between race/ethnicity and mode of delivery have been restricted to American populations. Black women are more likely to have failed IOL than non-Hispanic white women 23,25 and are also more likely to have repeat CS 26,27 . Biological differences in pelvic architecture and connective tissue, labor prolongation and the likelihood of fetal compromise between ethnic groups have been proposed to explain these findings 26 .…”

Factors leading to satisfaction with counseling for Labor after Cesarean among Latina women in the United States

“…This issue is critical, given that the majority of women undergoing LAC or elective RCB do not have a clear understanding of the relative risks and benefits of each method 7,8 . The absence of informed decision making is particularly worrisome for Latina women as they appear to have a lower likelihood of LAC success compared with non‐Latina women 9,10 …”

“…However, other studies have found that Latina women value having family support and involvement in their prenatal care and that their own beliefs and experiences greatly influence their decisions 15‐17 . In either case, provider bias has frequently been proposed as a factor that may directly or indirectly influence medical discussions about mode of delivery 10 …”

The Role of Race and Ethnicity in the Choice of a Vaginal Trial of Labor After Cesarean

“…11 The relationship of VBAC success prediction in the Latina community is particularly worthy of note, given some reported disparate findings. 11 Interestingly, whatever the complex interactions of the pelvic bony dimensions and soft tissue dynamics are, the vaginal birth statistics do not appear to show significant differences between women in different racial/ethnic groups, in the United States. 12 The use of racial identity may not therefore be statistically relevant to any of the algorithms used for successful VTOL prediction.…”