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.


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.
King
D E
DE
Department of Economics, State University of New York, Albany 12222.
Lahiri
K
K
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*