Related Experiment Video
Updated: Jan 28, 2026
Candidate Gene Testing in Clinical Cohort Studies with Multiplexed Genotyping and Mass Spectrometry
Published on: June 21, 2018
Disparities in planned and successful vaginal delivery after a cesarean delivery by body mass index: a
Emily Gray1, Mary M Brown2, Christy G Woolcott1,3
1Department of Obstetrics & Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (Gray, Woolcott, Allen, Scott, Mehrabadi).
Background:
Previous literature suggests that pregnant individuals with obesity have fewer planned and successful vaginal births following a previous cesarean delivery. Concern is growing that discrimination based on body mass index (BMI) and comorbidities associated with BMI, rather than BMI itself, are primarily responsible for these findings.
Objective:
To describe disparities in planning and having a successful vaginal delivery after a previous cesarean delivery by BMI status.
Study Design:
This population-based cohort study included all singleton pregnancies ≥37 weeks' gestation from 2003 to 2021 in Nova Scotia, Canada, with one previous cesarean and without contraindications for a trial of labor. Adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression, incorporating inverse probability weighting to account for confounding by demographic characteristics and co-morbidities.
Results:
Among 12 646 deliveries, approximately 31% experienced pre-pregnancy obesity. Of those with obesity, 34% planned a vaginal birth compared to 44% of those without obesity (aRR: 0.82, 95% CI: 0.78, 0.86). Higher BMI classification was associated with a reduced likelihood of planned vaginal delivery: class I: 37%, aRR: 0.88 (95% CI: 0.82, 0.94); class II: 32%, aRR: 0.81 (95% CI: 0.74, 0.89); class III: 26%, aRR 0.65 (95% CI: 0.56, 0.75). Among those planning a vaginal delivery, those with obesity were less likely to have a vaginal birth compared to those without obesity (57% vs 69%; aRR: 0.87, 95% CI: 0.82, 0.92); successful vaginal birth was less likely as BMI increased.
Conclusion:
Obesity was associated with reduced planned and successful vaginal delivery after a previous cesarean delivery and the association was most pronounced at higher BMI after accounting for demographic characteristics and co-morbidities. While discrimination based on BMI was unmeasured, notable disparities in planning and having a vaginal delivery by BMI suggest that training for health care providers and the availability of appropriate infrastructure may help optimize care for this population.
Related Concept Videos
02:17Ecological Succession
01:16Drug Delivery: Overview
Enteral delivery involves administering drugs directly through swallowing, sublingual placement, or buccal application. Orally administered drugs predominantly navigate the...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
01:36Delivery Pathways to the Lysosome
Endocytosis
In endocytosis, the cell membrane takes up macromolecules and particles from the surrounding medium. Clathrin-mediated...
01:18Drug Delivery: Enteral Route
01:29Drug Delivery: Parenteral Route
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...