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Operative Obstetrics

Poster Session 4

(1180) Social Disparities in Patients with a history of prior Cesarean

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Since ACOG’s call to decrease incidence of non-medically indicated cesarean deliveries (CDs), many providers encourage trial of labor after cesarean (TOLAC).  Since social factors impact TOLAC and vaginal birth after cesarean (VBAC), this study reviewed disparities in characteristics of patients choosing a TOLAC vs. elective repeat cesarean delivery (ERCD) at a single New York hospital.

Study Design: This was a retrospective cohort of 1,369 deliveries of patients with a history of prior CD between April 29, 2015 – April 29, 2020. Subjects were divided by delivery choice (opting for a TOLAC or ERCD) and had one of two delivery outcomes (VBAC or a repeat CD). Disparities were examined among different social categories including race/ethnicity (White, Asian, Black/ African American, Hispanic/ Latina, Other), health insurance (commercial, public), and pre-pregnancy body mass index (BMI) (< 30, 30-39.9, >40). Chi-squared tests examined proportional differences.

Results: There were significant disparities between patients regarding both cohort and delivery outcome. Patients with a race/ethnicity of “Hispanic/Latina” or “Other” more often opted for and delivered by CD (p < 0.001). Patients with public insurance more often chose TOLAC and delivered by VBAC (p < 0.001). Patients with a pre-pregnancy BMI of 40+ more often chose TOLAC (p < 0.001) but had a lower VBAC rate (p < 0.01). Intersections of these categories exist such that publicly insured patients had higher BMI (p < 0.001) and certain racial/ethnic groups were more likely to be publicly or privately insured (p < 0.001).

Conclusion: These findings suggest that certain patients more often elect for repeat CD while others more often choose TOLAC and deliver by VBAC. Race and ethnicity reflect social determinants of health such that disparities may reflect systemic racism within the delivery space. The picture is more complicated at the intersection of insurance and BMI. Additional research among patients with a history of CD is needed.