Low-risk patients who had a previous C-section birth at a predominantly Black hospital (BSH) are more likely to attempt and have a successful vaginal delivery in their next pregnancy than those at a hospital with few Black patients, a new UCLA-led study finds.
Still, the researchers found that regardless of hospital type, black patients were less likely than white patients to have a successful vaginal birth after cesarean section (VBAC).
Black women in the United States have higher rates of C-section births and already face much higher rates of severe pregnancy complications and mortality. Our findings show that where you give birth matters, and that certain hospitals appear to be better equipped or more willing to support delivery after caesarean section, even for patients at high risk of adverse obstetric outcomes. ”
Dr. Max Jordan Guemeni, assistant professor in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at the University of California, Los Angeles, and lead author of the study
The paper will be published in a peer-reviewed journal Obstetrics and gynecology.
Researchers analyzed 2017-2019 data from the U.S. National Inpatient Sample for more than 1.7 million patients who underwent caesarean section, focusing only on low-risk deliveries. They divided hospitals into three categories. These are hospitals with a high number of black patients, hospitals with a medium number of black patients, and hospitals with a low number of black patients.
They discovered:
- Patients with high BSH were 25% more likely to attempt delivery than those in facilities with few black patients, and about 75% were successful, particularly in urban teaching hospitals.
- In contrast, in hospitals with low BSH, approximately 18% of patients attempted to deliver, and approximately 70% of these were successful.
- Overall, black patients in high-BSH hospitals were 72% more likely to have a successful VBAC at any type of hospital, compared to 67% more likely in low-BSH facilities.
Avoiding unnecessary repeat C-sections will improve maternal health and safety, reduce long-term health risks and reduce healthcare costs, Goumeni said.
“C-section births increase the risk of complications such as infection and bleeding, and future pregnancy complications such as placenta accreta, which is on the rise,” she said. “These risks accumulate with each repeat C-section.”
Previous research has found that hospitals serving Black people receive poorer quality care, he said. These latest findings add nuance by showing that BSH can outperform other hospitals on some outcomes by supporting post-cesarean deliveries. Highlighting the role of institutional practices, resources, and culture in the provision of care. And it highlights how racial disparities and hospital segregation work together rather than separately.
“In short, inequality is not inevitable, but rather shaped by existing institutions and individual decisions,” he said.
Guemeni said two discoveries in particular stood out. First, BSHs were often under-resourced and had high delivery rates after cesarean sections and VBACs, especially in teaching hospitals. Another is that teaching hospitals showed significant differences in the number of black patients they treated, even when resources were the same.
“This suggests that culture, norms and clinical comfort, as well as technology and resources, play important roles,” he said. “These challenge simplistic narratives about hospital quality and highlight that positive lessons may already exist.”
Limitations of the study include the inability of the researchers to distinguish between patients who had one or more cesarean sections, and the cross-sectional nature of the data precludes determining causality.
The next step in the research is to investigate staffing models. Labor management protocols and the use of surgical vaginal delivery. How clinical decision-making tools are used. and the training, experience, and organizational culture to understand why some hospitals are better than others.
Dr. Adebayo Adesomo of HCA Houston Healthcare and Dr. Jae-wan Kim and Dr. Michelle Devink of the University of Utah are co-authors of the study.
March of Dimes and the American Board of Obstetrics and Gynecology funded this study.
Dr. Nguemeni has also received funding from the UCLA RCMAR Center for Health Innovation and Elderly Care Maximization (CHIME) under NIH/NIA grant P30-AG021684 and NIH/NCATS UCLA CTSI grant number UL1TR001881.
sauce:
University of California, Los Angeles Health Sciences
Reference magazines:
Tiaco, N. others. (2026). Segregation of labor and delivery services by race and its association with delivery trials and the use of vaginal delivery after cesarean section. Obstetrics and gynecology. DOI: 10.1097/AOG.0000000000006313. https://journals.lww.com/greenjournal/fulltext/9900/association_between_racial_segregation_of_labor.1528.aspx
