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

Melissa G. Rosenstein, Miriam Kuppermann, Steven E. Gregorich, Erika Cottrell, Aaron Caughey, Yvonne W. Cheng

Research output: Contribution to journalArticle

17 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1010-1017
Number of pages8
JournalObstetrics and Gynecology
Volume122
Issue number5
DOIs
StatePublished - Nov 2013

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Vaginal Birth after Cesarean
Term Birth
Birth Certificates
Pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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Association between vaginal birth after cesarean delivery and primary cesarean delivery rates. / Rosenstein, Melissa G.; Kuppermann, Miriam; Gregorich, Steven E.; Cottrell, Erika; Caughey, Aaron; Cheng, Yvonne W.

In: Obstetrics and Gynecology, Vol. 122, No. 5, 11.2013, p. 1010-1017.

Research output: Contribution to journalArticle

Rosenstein, Melissa G. ; Kuppermann, Miriam ; Gregorich, Steven E. ; Cottrell, Erika ; Caughey, Aaron ; Cheng, Yvonne W. / Association between vaginal birth after cesarean delivery and primary cesarean delivery rates. In: Obstetrics and Gynecology. 2013 ; Vol. 122, No. 5. pp. 1010-1017.
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AB - 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.

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