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. 2013 Nov;122(5):1010-1017.
doi: 10.1097/AOG.0b013e3182a91e0f.

Association between vaginal birth after cesarean delivery and primary cesarean delivery rates

Melissa G Rosenstein  1 , Miriam Kuppermann, Steven E Gregorich, Erika K Cottrell, Aaron B Caughey, Yvonne W Cheng
Affiliations

Association between vaginal birth after cesarean delivery and primary cesarean delivery rates

Melissa G Rosenstein et al. Obstet Gynecol. 2013 Nov.

Abstract

Objective: To estimate the association between vaginal birth after cesarean delivery (VBAC) rates and primary cesarean delivery rates in California hospitals.

Methods: Hospital VBAC rates were calculated using birth certificate and discharge data from 2009, and hospitals were categorized by quartile of VBAC rate. Multivariable logistic regression analysis was performed to estimate the odds of cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation (nulliparous term singleton vertex) by hospital VBAC quartile while controlling for many patient-level and hospital-level confounders.

Results: There were 468,789 term singleton births in California in 2009 at 255 hospitals, 125,471 of which were low-risk nulliparous term singleton vertex. Vaginal birth after cesarean delivery rates varied between hospitals, with a range of 0-44.6%. Rates of cesarean delivery among low-risk nulliparous term singleton vertex women declined significantly with increasing VBAC rate. When adjusted for maternal and hospital characteristics, low-risk nulliparous term singleton vertex women who gave birth in hospitals in the highest VBAC quartile had an odds ratio of 0.55 (95% confidence interval 0.46-0.66) of cesarean delivery compared with women at hospitals with the lowest VBAC rates. Each percentage point increase in a hospital's VBAC rate was associated with a 0.65% decrease in the low-risk nulliparous term singleton vertex cesarean delivery rate.

Conclusion: Hospitals with higher rates of VBAC have lower rates of primary cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation.

Level of evidence: II.

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Figures

Fig. 1
Fig. 1
The distribution of hospital vaginal birth after cesar-ean delivery (VBAC) rates in California, 2009. This histogram shows the distribution of hospital VBAC rates and the median VBAC rate in California, 2009. Blue line indicates median VBAC rate. Rosenstein. Hospital VBAC and Primary Cesarean Rates. Obstet Gynecol 2013.
Fig. 2
Fig. 2
Low-risk nulliparous term singleton vertex (NTSV) cesarean delivery rates and vaginal birth after cesarean delivery rates (VBAC) in California hospitals, 2009. This scatterplot shows the VBAC and NTSV cesarean delivery rates with an unadjusted linear regression line demonstrating their inverse relationship. Rosenstein. Hospital VBAC and Primary Cesarean Rates. Obstet Gynecol 2013.
See this image and copyright information in PMC

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