Socioeconomic Factors and the Odds of Vaginal Birth After Cesarean Delivery

OBJECTIVE: To determine the independent effect of socioeconomic, organizational, and professional liability factors on the odds of vaginal birth after cesarean delivery (VBAC) while controlling for important clinical factors. DESIGN: A retrospective study of 1989 New York State vital statistics data, supplemented with additional information on county- and hospital-specific variables. Using multiple logistic regression analysis, odds ratios (ORs) and 95% confidence intervals (CIs) were derived for 15 independent variables. SETTING: Births occurring in 104 New York State hospitals. DATA SET: A total of 13, 944 births occurring to New York State residents with a history of cesarean delivery of which 3068 (22%) were vaginal deliveries. RESULTS: The odds of VBAC increased with maternal education. The ORs were 1. 15 (95% CI, 0. 99 to 1. 34) for 12 years of education; 1. 36 (95% CI, 1. 16 to 1. 60) for 13 to 15 years; 1. 59 (95% CI, 1. 32 to 1. 93) for 16 years, and 2. 00 (95% CI, 1. 64 to 2. 45) for 17 years or more. The ORs also increased with the level of care provided by the hospital; they were 1. 55 (95% CI, 1. 34 to 1. 81) and 1. 30 (95% CI, 1. 18 to 1. 44) for hospitals with intensive and intermediate neonatal care facilities, respectively. The ORs were 1. 15 (95% CI, 1. 02 to 1. 30) for health maintenance organization participants and 0. 77 (95% CI, 0. 63 to 0. 94) for women giving birth in government hospitals. The ORs of VBAC for African-American and Hispanic mothers were 0. 80 (95% CI, 0. 70 to 0. 93) and 0. 61 (95% CI, 0. 51 to 0. 73), respectively. The ORs for a 5000 increase in physician's yearly malpractice premium and the hospital's paid loss due to malpractice claim settlements were 0. 98 (95% CI, 0. 97 to 0. 99) and 1. 01 (95% CI, 0. 99 to 1. 03), respectively. CONCLUSIONS: In addition to clinical factors, a mother's level of education and ethnicity and specific characteristics of the hospital in which she delivers affect the odds of a vaginal delivery after a previous cesarean delivery. From our analysis, we cannot conclude that professional liability factors affected VBAC rates.