{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T23:20:59Z","timestamp":1787872859796,"version":"build-2784847793"},"reference-count":31,"publisher":"Georg Thieme Verlag KG","funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"crossref","award":["R21MD018075"],"award-info":[{"award-number":["R21MD018075"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Among those with a prior cesarean, Black individuals are more likely to have labor after cesarean compared with White individuals but have lower rates of vaginal birth after cesarean following labor. However, little is known about indications for cesarean among these patients. We examined whether indication for unplanned cesarean delivery varied by race and ethnicity among individuals with one prior cesarean.<\/jats:p>\n                  <jats:p>Using linked Massachusetts birth certificate and hospital discharge data (2012\u20132022), we identified individuals with one prior cesarean who labored and subsequently had an unplanned cesarean. Indications were categorized as nonreassuring fetal status, labor dystocia\/arrest, or other. A multilevel multinomial logit model assessed associations between race and ethnicity and cesarean indication, adjusting for covariates.<\/jats:p>\n                  <jats:p>Overall, 41% had cesarean for nonreassuring fetal status, 16% for labor dystocia\/arrest, and 43% for other indications. Nonreassuring fetal status was the indication for 59% of Black patients versus 36% of White patients. In adjusted analyses, Black individuals had a 42% higher relative risk of having a cesarean for an indication of nonreassuring fetal status, compared with White individuals and compared with having a cesarean for an indication of labor arrest\/dystocia (relative risk ratio: 1.42, 95% confidence interval: 1.14\u20131.76). Black and Latinx individuals had a lower relative risk of having a cesarean for other indication, compared with White individuals and compared with cesarean for an indication of labor arrest\/dystocia.<\/jats:p>\n                  <jats:p>Racial and ethnic differences exist in indications for unplanned cesarean after labor among those with one prior cesarean, mirroring disparities reported for primary cesarean indications.<\/jats:p>","DOI":"10.1055\/a-2936-5429","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T23:13:14Z","timestamp":1786576394000},"source":"Crossref","is-referenced-by-count":0,"title":["Racial and Ethnic Differences in Indications for Repeat Cesarean following Labor after Cesarean"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9294-0718","authenticated-orcid":false,"given":"Laura B.","family":"Attanasio","sequence":"additional","affiliation":[{"name":"University of Massachusetts Amherst, Massachusetts, United States","place":["Amherst"],"department":["Department of Health Promotion and Policy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Laws","sequence":"additional","affiliation":[{"name":"University of Massachusetts Amherst, Massachusetts, United States","place":["Amherst"],"department":["Center for Research on Families"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Goff","sequence":"additional","affiliation":[{"name":"University of Massachusetts Amherst, Massachusetts, United States","place":["Amherst"],"department":["Department of Health Promotion and Policy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sindhu K.","family":"Srinivas","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"issue":"01","key":"ref1","first-page":"1","article-title":"Births: final data for 2023","volume":"74","author":"M JK Osterman","year":"2025","journal-title":"Natl Vital Stat Rep"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1097\/01.AOG.0000444441.04111.1d","article-title":"Gynecologists. Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1","volume":"123","author":"American College of Obstetricians","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/AOG.0000000000004620","article-title":"Racial and ethnic inequities in cesarean birth and maternal morbidity in a low-risk, nulliparous cohort","volume":"139","author":"M P Debbink","year":"2022","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/AOG.0b013e31821e5f65","article-title":"Indications contributing to the increasing cesarean delivery rate","volume":"118","author":"E L Barber","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"e235428","DOI":"10.1001\/jamanetworkopen.2023.5428","article-title":"Cesarean delivery trends among patients at low risk for cesarean delivery in the US, 2000-2019","volume":"6","author":"A M Frappaolo","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1186\/1471-2393-13-168","article-title":"Racial and ethnic differences in primary, unscheduled cesarean deliveries among low-risk primiparous women at an academic medical center: a retrospective cohort study","volume":"13","author":"J K Edmonds","year":"2013","journal-title":"BMC Pregnancy Childbirth"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1007\/s40615-020-00842-3","article-title":"Examining cesarean delivery rates by race: a population-based analysis using the Robson ten-group classification system","volume":"8","author":"E G Valdes","year":"2021","journal-title":"J Racial Ethn Health Disparities"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1055\/s-0039-1697587","article-title":"The association between maternal race and ethnicity and risk factors for primary cesarean delivery in nulliparous women","volume":"38","author":"E L Stark","year":"2021","journal-title":"Am J Perinatol"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1111\/birt.12108","article-title":"The influence of detailed maternal ethnicity on cesarean delivery: findings from the U.S. birth certificate in the State of Massachusetts","volume":"41","author":"J K Edmonds","year":"2014","journal-title":"Birth"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1055\/s-0041-1740071","article-title":"Racial disparities in the rates of and indications for cesarean delivery in California: are they changing over time?","volume":"41","author":"E N Teal","year":"2024","journal-title":"Am J Perinatol"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1097\/AOG.0000000000002343","article-title":"Racial and ethnic differences in utilization of labor management strategies intended to reduce cesarean delivery rates","volume":"130","author":"L M Yee","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1186\/s12884-020-03095-4","article-title":"Factors associated with unplanned primary cesarean birth: secondary analysis of the listening to mothers in California survey","volume":"20","author":"C Sakala","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"issue":"08","key":"ref13","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1055\/s-0038-1675207","article-title":"Racial and ethnic disparities in maternal outcomes and the disadvantage of peripartum Black women: a multistate analysis, 2007-2014","volume":"36","author":"V Tangel","year":"2019","journal-title":"Am J Perinatol"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1055\/a-1785-8843","article-title":"Mode of delivery and unplanned cesarean: differences in rates and indication by race, ethnicity, and sociodemographic characteristics","volume":"41","author":"A Williams","year":"2024","journal-title":"Am J Perinatol"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1007\/s40615-021-01057-w","article-title":"Racial and ethnic disparities in cesarean delivery and indications among nulliparous, term, singleton, vertex women","volume":"9","author":"I C Okwandu","year":"2022","journal-title":"J Racial Ethn Health Disparities"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1111\/birt.12906","article-title":"Racial disparities in nulliparous singleton term vertex cesarean deliveries: rates, reasons, and time to delivery","volume":"52","author":"K McCloskey","year":"2025","journal-title":"Birth"},{"issue":"12","key":"ref17","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.1089\/jwh.2020.8801","article-title":"Racial\/ethnic differences in socioeconomic status and medical correlates of trial of labor after cesarean and vaginal birth after cesarean","volume":"30","author":"L B Attanasio","year":"2021","journal-title":"J Womens Health (Larchmt)"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1097\/01.AOG.0000259313.46842.71","article-title":"Predicting failure of a vaginal birth attempt after cesarean delivery","volume":"109","author":"S K Srinivas","year":"2007","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/AOG.0000000000003845","article-title":"Trial of labor after two prior cesarean deliveries: patient and hospital characteristics and birth outcomes","volume":"136","author":"M Dombrowski","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"100530","DOI":"10.1016\/j.ajogmf.2021.100530","article-title":"Obstetric comorbidity scores and disparities in severe maternal morbidity across marginalized groups","volume":"4","author":"S A Leonard","year":"2022","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1055\/s-0041-1740071","article-title":"Racial disparities in the rates of and indications for cesarean delivery in California: are they changing over time?","volume":"41","author":"E Nicole Teal","year":"2024","journal-title":"Am J Perinatol"},{"key":"ref22","first-page":"1285","volume-title":"Racial and ethnic differences in utilization of labor management strategies intended to reduce cesarean delivery rates","author":"L M Yee","year":"2017"},{"issue":"06","key":"ref23","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1097\/AOG.0b013e3181fdef6e","article-title":"Contemporary patterns of spontaneous labor with normal neonatal outcomes","volume":"116","author":"J Zhang","year":"2010","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/birt.12247","article-title":"Electronic fetal monitoring and cesarean birth: a scoping review","volume":"43","author":"M T Paterno","year":"2016","journal-title":"Birth"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"163.e1","DOI":"10.1016\/j.ajog.2016.10.009","article-title":"The limits of electronic fetal heart rate monitoring in the prevention of neonatal metabolic acidemia","volume":"216","author":"S L Clark","year":"2017","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref26","first-page":"CD006066","article-title":"Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour","volume":"2","author":"Z Alfirevic","year":"2017","journal-title":"Cochrane Database Syst 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Race, class, and the realization of natural birth preferences, 2002\u20132013","volume":"68","author":"K M Johnson","year":"2021","journal-title":"Soc Probl"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2936-5429.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T23:10:49Z","timestamp":1787872249000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2936-5429"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":31,"URL":"https:\/\/doi.org\/10.1055\/a-2936-5429","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8,12]]},"published":{"date-parts":[[2026,8,12]]}}}