Photo Credit: William Fortunato
Scientific Frontline: Extended "At a Glance" Summary: Vaginal Birth After Cesarean (VBAC) Outcomes at Black-Serving Hospitals
The Core Concept: Low-risk patients with a previous Cesarean section are significantly more likely to attempt and successfully achieve a vaginal delivery at predominantly Black-serving hospitals than at hospitals serving fewer Black patients.
Key Distinction/Mechanism: While prior research often associated predominantly Black-serving hospitals with lower-quality care, this study demonstrates these specific institutions are actually better equipped culturally and procedurally to support vaginal birth after Cesarean (VBAC), indicating that institutional norms drive outcomes more than sheer medical resources.
Origin/History: Published in Obstetrics & Gynecology, this UCLA-led research analyzed 2017–2019 data from the US National Inpatient Sample, evaluating over 1.7 million low-risk patients with a history of Cesarean delivery.
Major Frameworks/Components:
- Hospitals were stratified into high, medium, and low Black-serving categories.
- Patients at high Black-serving facilities were 25% more likely to attempt labor following a prior Cesarean, achieving an approximate 75% success rate.
- In contrast, only 18% of patients at low Black-serving hospitals attempted labor, achieving a 70% success rate.
- Black patients at high Black-serving hospitals had an overall 72% higher likelihood of a successful VBAC compared to a 67% probability at low Black-serving facilities.
- The research indicates that institutional culture, clinical comfort, and established labor protocols are critical drivers of VBAC success in teaching hospitals.
Branch of Science: Obstetrics and Gynecology, Public Health, Health Equity.
Future Application: The data provides a foundation for redesigning hospital staffing models, labor management protocols, and clinical decision tools to safely decrease unnecessary repeat Cesareans across broader healthcare systems.
Why It Matters: Reducing repeat Cesarean deliveries minimizes the risk of severe maternal complications, such as infection, hemorrhage, and placenta accreta. Furthermore, it highlights that systemic healthcare disparities are not inevitable but can be disrupted by positive institutional practices.
Low-risk patients at predominantly Black-serving hospitals (BSHs) who previously gave birth through cesareans are more likely to attempt and successfully complete a vaginal delivery in a subsequent pregnancy than are those at hospitals treating few Black patients, new UCLA-led research finds.
Still, Black patients were less likely to achieve a successful vaginal birth after cesarean (VBAC) than their white counterparts, regardless of hospital type, the researchers found.
“Black women in the United States have a higher rate of cesarean deliveries and already face much higher rates of severe pregnancy complications and death,” said Dr. Max Jordan Nguemeni, an assistant professor of medicine in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA and the study's lead author. “Our findings show that where someone gives birth matters, and that certain hospitals appear better equipped or more willing to support labor after cesarean, even for patients who face higher risks of adverse obstetric outcomes.”
The researchers analyzed 2017–2019 data from the US National Inpatient Sample on more than 1.7 million patients who had undergone cesareans, focusing only on low-risk deliveries. They grouped hospitals into three categories: high Black-serving hospitals, medium Black-serving hospitals, and low Black-serving hospitals.
They found that patients at high BSHs were 25% more likely to attempt labor than those at facilities serving few Black patients, and about 75% succeeded, particularly at urban teaching hospitals. In contrast, about 18% of patients at low BSHs attempted labor, with about 70% of them succeeding. Overall, Black patients at high BSHs had a 72% probability of a successful VBAC, compared with a 67% probability at low BSH facilities.
Avoiding unnecessary repeat cesareans improves maternal health and safety, reduces long-term health risks, and lowers healthcare costs, Nguemeni said.
“Cesarean births carry higher risks of complications like infection, bleeding, and future pregnancy complications like placenta accreta, which is on the rise,” he said. “These risks accumulate with each repeat cesarean.”
Previous research found that Black-serving hospitals provided worse care, he said. These latest findings add nuance by showing that BSHs can perform better than other hospitals on some outcomes by supporting labor following cesareans. They shine a light on the role that institutional practices, resources, and culture play in providing care, and they highlight how racial disparities and hospital segregation work together rather than operate separately.
“In short, disparities are not inevitable; they are shaped by existing systems and individuals' decisions,” he said.
Two findings stood out in particular, Nguemeni said. First, BSHs are often underresourced yet had higher rates of labor after cesarean and VBAC, particularly at teaching hospitals. Second, teaching hospitals demonstrated large differences depending on the number of Black patients they treated, even when their resources were similar.
“This suggests that culture, norms, and clinical comfort, and not just technology and resources, play an important role,” he said. “These findings challenge simplistic narratives about hospital quality and highlight where positive lessons may already exist.”
Study limitations include the researchers' inability to distinguish between patients with single or multiple cesarean deliveries, as well as an inability to determine causation due to the cross-sectional nature of the data.
The next steps in the research are to examine staffing models, labor management protocols, and the use of operative vaginal delivery; to understand how clinical decision tools are used; and to evaluate the role of training, experience, and institutional culture in understanding why some hospitals perform better than others.
Additional information: Dr. Adebayo Adesomo of HCA Houston Healthcare, and Jaewhan Kim and Dr. Michelle Debbink, both of the University of Utah, coauthored the study.
Funding: The March of Dimes and the American Board of Obstetrics and Gynecology funded the study. Dr. Nguemeni also receives funding from the UCLA RCMAR Center for Health Innovation and Maximizing Eldercare under NIH/NIA grant P30-AG021684 and NIH/NCATS UCLA CTSI grant UL1TR001881.
Published in journal: Obstetrics & Gynecology
Authors: Nguemeni Tiako, Max Jordan MD, MS; Adesomo, Adebayo MD; Kim, Jaewhan PhD; Debbink, and Michelle P. MD, PhD
Source/Credit: University of California, Los Angeles / Health
Reference Number: med051726_01
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