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Do vaginal birth after cesarean outcomes differ based on hospital setting?
Emily A DeFranco1, Roxane Rampersad, Kristin L Atkins
1Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA. defrancoe@wudosis.wustl.edu
American Journal of Obstetrics and Gynecology
|October 2, 2007
Summary
Vaginal birth after cesarean (VBAC) outcomes are similar across different hospital settings. Complication rates for VBAC attempts remain low, regardless of whether the hospital has an obstetrics-gynecology residency program or is a university or community facility.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Reproductive Medicine
Background:
- Vaginal birth after cesarean (VBAC) is a common choice for women with a prior cesarean delivery.
- Hospital setting may influence VBAC success rates and safety.
- Previous research has not conclusively determined if hospital environment impacts VBAC outcomes.
Purpose of the Study:
- To evaluate if hospital setting affects outcomes for women attempting vaginal birth after cesarean (VBAC).
- To test the hypothesis that VBAC outcomes are equivalent across different hospital environments.
Main Methods:
- Retrospective cohort study of 25,065 women with prior cesarean deliveries from 1996-2000.
- Comparison of VBAC outcomes between hospitals with and without obstetrics-gynecology residency programs.
- Analysis of VBAC outcomes in university versus community hospitals using logistic regression.
Main Results:
- VBAC attempt rates varied by hospital setting, with higher rates in university and residency-affiliated hospitals.
- Failed VBAC, blood transfusion, and composite adverse outcomes did not significantly differ by hospital setting.
- Uterine rupture rates were slightly higher in community hospitals (1.2%) compared to university hospitals (0.6%), but remained low overall.
Conclusions:
- The hospital setting does not significantly impact the majority of VBAC outcomes.
- VBAC-associated complications are infrequent and generally not dependent on the hospital environment.
- The study supports the safety of VBAC across diverse hospital settings.
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