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Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study.
Yung-Hsiang Ying1, George Linn2,3, Koyin Chang4,5
1College of Management, National Taiwan Normal University, Taipei 116, Taiwan.
Journal of Clinical Medicine
|August 15, 2019
Summary
The low rate of vaginal birth after cesarean (VBAC) in Taiwan is influenced by non-medical factors and institutional effects. Policy changes temporarily boosted VBAC rates, highlighting the need for ongoing reviews and improved patient education.
Area of Science:
- Maternal Health
- Health Policy
- Reproductive Health Economics
Background:
- The rate of vaginal birth after cesarean (VBAC) in Taiwan is notably low, attributed to high perceived risks of trial of labor after cesarean (TOLAC).
- Existing policies, including increased National Health Insurance (NHI) payments for vaginal birth delivery, have shown only temporary impacts on VBAC rates.
Purpose of the Study:
- To analyze factors influencing women's choice of birth method after a previous cesarean section (CS).
- To provide evidence for public authorities to develop guidelines and optimize health insurance policies to increase VBAC rates.
Main Methods:
- Utilized National Health Insurance (NHI) claim data to analyze birth method adoption in women with prior CS.
- Employed logit, probit, and hierarchical regression models, controlling for demographics, incentives, and provider characteristics.
Main Results:
- VBAC rates show a decreasing trend despite policy interventions.
- Significant factors influencing VBAC adoption include institution-specific effects, pregnancy comorbidities, income, fertility, and weekend admissions.
- Non-medical considerations appear to dominate women's birth method choices.
Conclusions:
- Current health insurance policies have limited long-term effectiveness in increasing VBAC rates.
- The study suggests a need for enhanced health education for patients and updated training for healthcare providers.
- Systematic policy reviews and a focus on non-medical factors are crucial for promoting safe birth practices.
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