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. 2024 Apr 5;24(1):243.
doi: 10.1186/s12884-024-06458-3.

Examining provider practice-level disparities in delivery outcomes among patients with a history of Cesarean Delivery

Lily McCarthy  1 , Nicola F Tavella  2   3 , Sara Wetzler  1 , Lily Ardente  1 , Molly Chadwick  4 , Dexter Paul  5 , Nikki Sabet  5 , Toni Stern  5 , Angela Bianco  5   6
Affiliations

Examining provider practice-level disparities in delivery outcomes among patients with a history of Cesarean Delivery

Lily McCarthy et al. BMC Pregnancy Childbirth. .

Abstract

Background: Choosing whether to pursue a trial of labor after cesarean (TOLAC) or scheduled repeat cesarean delivery (SRCD) requires prenatal assessment of risks and benefits. Providers and patients play a central role in this process. However, the influence of provider-associated characteristics on delivery methods remains unclear. We hypothesized that different provider practice groups have different obstetric outcomes in patients with one prior cesarean delivery (CD).

Methods: This was a retrospective cohort study of deliveries between April 29, 2015 - April 29, 2020. Subjects were divided into three cohorts: SRCD, successful VBAC, and unsuccessful VBAC (patients who chose TOLAC but had a CD). Disparities were reviewed between five different obstetric provider practice groups, determined from a breakdown of different providers delivering at the study site during the study period. Proportional differences were examined using Chi-squared tests and logistic regression models.

Results: 1,439 deliveries were included in the study. There were significant proportional disparities between patients in the different groups. Specifically, patients from Group D were significantly more likely to undergo successful VBAC, while patients seeing a provider from Group A were more likely to deliver by SRCD. In our multivariate analysis of successful versus unsuccessful VBAC, patients from Group D had greater odds ratios of successful VBAC compared to Group A. Patients delivered by Group E had a significantly lower odds ratio of successful VBAC.

Conclusion: This study suggests an association between provider practice groups and delivery outcomes among patients with one prior CD. These data contribute to a growing body of literature around patient choice in pregnancy and the interplay of patients and providers. These findings help to guide future investigations to improve outcomes among patients with a history of CD.

Keywords: Midwifery; Multivariate analysis; Obstetrics; Pregnancy; Retrospective studies; Trial of labor.

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Conflict of interest statement

The authors declare no competing interests.

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