Socioeconomic factors and the odds of vaginal birth after cesarean delivery
D. E. King and K. Lahiri
Department of Economics, State University of New York, Albany 12222.
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.
