title: Socioeconomic factors and the odds of vaginal birth after cesarean delivery.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  Births occurring in 104 New York State hospitals.
  
  
  METHODS
  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.
authors.affiliation: Department of Economics, State University of New York, Albany 12222.
authors.forename: D E
authors.initials: DE
authors.lastname: King
authors.forename: K
authors.initials: K
authors.lastname: Lahiri
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D004522:Educational Status; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D016365:Liability, Legal; D016015:Logistic Models; D008318:Malpractice / Q000706:statistics & numerical data; D008423:Maternal Age; D009518:New York; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D012044:Regression Analysis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*