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Impact of Sociodemographic and Hospital Factors on Attempts at Vaginal Birth After Cesarean Delivery

From the Department of Obstetrics and Gynecology, University of Pennsylvania Health System; Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and Women and Infants Hospital, Brown University School of Medicine, Providence, Rhode Island.

Address reprint requests to: George Macones, MD, MSCE, Director, Maternal Fetal Medicine, 2000 Courtyard Building, 3400 Spruce Street, Philadelphia, PA 19104-4283; E-mail: gmacones{at}mail.obgyn.upenn.edu.

OBJECTIVE: To estimate the clinical and nonclinical factors associated with whether a patient attempts a trial of labor after previous cesarean delivery or elects to have a repeat cesarean delivery.

METHODS: We conducted a retrospective, cohort study comparing all women with previous low transverse cesarean delivery who attempted a trial of labor with those who elected to have a repeat cesarean delivery. Data from 17 hospital sites for the period 1995–1998 were included, for a total of 15,172 patients. Bivariate, site-adjusted, and multivariable logistic regression analyses were used.

RESULTS: Odds of trial of labor by hospital were not uniform in the unadjusted or adjusted analyses. The odds of trial of labor decreased significantly with increasing age, gravidity, and number of previous cesarean deliveries. Medicaid patients had higher odds of trial of labor than did privately insured patients (odds ratio [OR] 1.37 [95% confidence interval (CI) 1.20, 1.55]). Patients with nonrecurrent indication for previous cesarean delivery had generally higher odds of trial of labor than did those with a recurrent indication. Black women were more likely to attempt trial of labor than were white women (OR 2.17 [95% CI 1.83, 2.56] for those with a nonrecurrent indication).

CONCLUSION: Clinical and nonclinical factors influence rates of attempted vaginal birth after cesarean delivery.

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