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Vaginal birth after cesarean in California
J Melnikow1, P Romano, W M Gilbert
1Department of Family and Community Medicine, University of California, Davis, Sacramento, California 95817, USA. jamelnikow@ucdavis.edu
Obstetrics and Gynecology
|September 1, 2001
Summary
Women with previous cesareans received trial of labor counseling less often in high cesarean rate hospitals. This resulted in fewer vaginal births after cesarean (VBAC) in these facilities.
Area of Science:
- Obstetrics and Gynecology
- Health Services Research
- Patient Safety
Background:
- Cesarean delivery rates vary significantly across hospitals.
- Trial of labor after cesarean (TOLAC) is a key alternative to repeat cesarean delivery.
- Informed patient choice is crucial for TOLAC decisions.
Purpose of the Study:
- To compare trial of labor (TOL) offer and consent rates in California hospitals with varying risk-adjusted cesarean delivery rates.
- To assess the association between hospital cesarean rates and documented counseling for TOL.
Main Methods:
- Stratified sample of 51 California hospitals from 267 facilities (1992-1993).
- Hospitals categorized into high, medium, and low risk-adjusted cesarean rates using logistic regression.
- Medical record review of 369 women with prior cesareans to assess TOL counseling and delivery method.
Main Results:
- Hospitals with low cesarean rates documented TOL counseling in >99% of eligible women, versus 79% in high-rate hospitals (P <.001).
- Successful vaginal birth after cesarean (VBAC) rates were 71% in low-rate hospitals, compared to 31% in high-rate hospitals (P <.05).
Conclusions:
- High cesarean rate hospitals showed higher rates of repeat elective cesarean without documented TOL counseling.
- Lack of counseling hinders informed patient choice regarding TOL versus elective repeat cesarean.
- Ensuring documented counseling is vital for patient autonomy and appropriate delivery method selection.