Related Experiment Video
Updated: Aug 14, 2026
08:49
External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
Racial and ethnic differences in indications for repeat cesarean following labor after cesarean
Laura Attanasio1, Holly Laws2, Sarah Goff2
1University of Massachusetts Amherst, Department of Health Promotion and Policy, Massachusetts, United States, Amherst.
American Journal of Perinatology
|August 12, 2026
Summary
Racial disparities exist in unplanned cesarean delivery indications among individuals with a prior cesarean. Black individuals are more likely to undergo cesarean for nonreassuring fetal status compared to White individuals.
Area of Science:
- Obstetrics and Gynecology
- Health Disparities Research
- Perinatal Care
Background:
- Individuals with a prior cesarean delivery face disparities in labor after cesarean (LAC) and vaginal birth after cesarean (VBAC) rates.
- Indications for unplanned cesarean delivery among this population, particularly concerning race and ethnicity, remain understudied.
Purpose of the Study:
- To investigate if the indications for unplanned cesarean delivery differ by race and ethnicity among individuals with one prior cesarean undergoing labor.
- To identify specific racial and ethnic patterns in cesarean indications following labor in the context of a previous cesarean.
Main Methods:
- Utilized linked Massachusetts birth certificate and hospital discharge data from 2012-2022.
- Identified individuals with one prior cesarean who underwent labor followed by an unplanned cesarean.
- Employed a multilevel multinomial logit model to analyze associations between race/ethnicity and cesarean indications (nonreassuring fetal status, labor dystocia/arrest, other), adjusting for covariates.
Main Results:
- Nonreassuring fetal status was the most common indication (41%), followed by 'other' (43%) and labor dystocia/arrest (16%).
- Black patients had a significantly higher likelihood of cesarean for nonreassuring fetal status (59%) compared to White patients (36%).
- Adjusted analyses revealed Black individuals had a 42% higher relative risk of cesarean for nonreassuring fetal status compared to White individuals; Black and Latinx individuals had a lower relative risk for 'other' indications.
Conclusions:
- Significant racial and ethnic disparities exist in the indications for unplanned cesarean delivery after labor among individuals with a prior cesarean.
- These findings parallel disparities observed in primary cesarean delivery indications, highlighting persistent inequities in obstetric care.
Related Concept Videos
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:52Regression Toward the Mean
Regression toward the mean (“RTM”) is a phenomenon in which extremely high or low values—for example, and individual’s blood pressure at a particular moment—appear closer to a group’s average upon remeasuring. Although this statistical peculiarity is the result of random error and chance, it has been problematic across various medical, scientific, financial and psychological applications. In particular, RTM, if not taken into account, can interfere when researchers try to extrapolate results...