Skip to main content

Advertisement

SpringerLink
Log in

Demographic, Socioeconomic, Health Systems, and Geographic Factors Associated with Vaginal Birth After Cesarean: An Analysis of 2017 U.S. Birth Certificate Data

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

A Correction to this article was published on 07 April 2021

This article has been updated

Abstract

Objectives

In order to better understand the current rates of vaginal birth after cesarean (VBAC) in the United States, 2017 U.S. birth certificate data were used to examine sociodemographic and geographic factors associated with the outcome of a VBAC.

Methods

The 2017 Natality Limited Geography Dataset and block sequential logistic regression were used to examine sociodemographic and geographic factors associated with subsequent births in 2017 in the United States to women with a history of 1 or 2 cesareans (N = 540,711).

Results

The adjusted odds of VBAC were 6% higher for Black women (1.06; 95% CI: 1.04, 1.08) and 18% higher for American Indian/Alaska Native women (aOR 1.18; 95% CI: 1.10, 1.27) relative to white women. Asian/Pacific Islander women were 9% less likely to have a VBAC (aOR 0.91; 95% CI: 0.88, 0.94) than similar white women with a history of cesarean delivery. Latina women had a 10% less likelihood of a VBAC (aOR 0.90; 95% CI: 0.88, 0.92) when compared with non-Latina women. Women with a high school education (aOR 0.85; 95% CI: 0.83, 0.88) or some college (aOR 0.85; 95% CI: 0.84, 0.87) were less likely to have a VBAC than women educated at a baccalaureate level or higher. Women whose births were paid for by Medicaid had a 5% increased likelihood of VBAC over women with private insurance (aOR 1.05, 95% CI: 1.03, 1.07). Women who self-pay have twice the likelihood of VBAC (aOR 1.99; 95% CI: 1.92, 2.07) compared to women with private insurance. The adjusted odds of VBAC were lowest for women giving birth in Southern states (aOR 0.72; 95% CI: 0.71, 0.74) and highest for women giving birth in the Midwest (aOR 1.19; 95% CI: 1.16, 1.22) relative to women in the Northeastern U.S. Thirteen percent (13%) of women who had a VBAC had a certified nurse-midwife (CNM) birth attendant, which is 44% higher than the national CNM-attended birth rate.

Conclusions for Practice

Significant variation exists in VBAC rates based on a number of sociodemographic and geographic factors, likely reflecting disparities in access to vaginal birth after cesarean and differences in preference regarding mode of birth after cesarean. Further research is recommended to better understand and address these disparities to improve maternity care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Change history

References

  • ACNM: American College of Nurse Midwives Board of Directors. (2017). ACNM Positon Statement: Vaginal Birth After Cesarean. Silver Spring, MD: ACNM: American College of Nurse Midwives Board of Directors. https://doi.org/10.1111/j.1552-6909.2012.01388.x.

  • American College and of Obstetricians and Gynecologists. (1999). ACOG practice bulletin. Vaginal birth after previous cesarean delivery. Number 2, October 1998 American College of Obstetricians and Gynecologists. (1999). ACOG practice bulletin. Vaginal birth after previous cesarean delivery. Number 2, October 1998. Clinical management guidelines for obstetrician-gynecologists. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 64(2), 201–208.

  • American College of Obstetricians and Gynecologists. (2010). ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstetrics & Gynecology, 116, 450–463. https://doi.org/10.1097/AOG.0b013e3181eeb251.

  • American College of Obstetricians and Gynecologists. (2017). Vaginal birth after cesarean delivery. Practice Bulletin Number 184. Obstetrics & Gynecology, 130(5), e217–e233.

  • American College of Obstetricians and Gynecologists. (2019). ACOG Practice Bulletin No. 205: Vaginal birth after cesarean delivery. Obstetrics & Gynecology, 133(2), e110–e127. https://doi.org/10.1097/AOG.0000000000003078

  • Attanasio, L. B., Kozhimannil, K. B., & Kjerulff, K. H. (2019). Women’s preference for vaginal birth after a first delivery by cesarean. Birth, 46(1), 51–60. https://doi.org/10.1111/birt.12386.

    Article  PubMed  Google Scholar 

  • Attanasio, L. B., & Paterno, M. T. (2019). Correlates of trial of labor and vaginal birth after cesarean in the United States. Journal of Women’s Health. https://doi.org/10.1089/jwh.2018.7270.

    Article  PubMed  PubMed Central  Google Scholar 

  • Barger, M. K., Dunn, J. T., Bearman, S., DeLain, M., Gates, E., McMahon, M., … Hamilton, B. (2013). A survey of access to trial of labor in California hospitals in 2012. BMC Pregnancy and Childbirth, 13(1), 83. https://doi.org/10.1186/1471-2393-13-83.

  • Basile Ibrahim, B. (2020). Pregnancy after cesarean: A mixed methods exploration of women’s experiences across the United States. Dissertation. Yale University.

  • Basile Ibrahim, B., Kennedy, H. P., & Whittemore, R. (2020). Women’s perceptions of barriers and facilitators to vaginal birth after cesarean in the United States: An integrative review. Journal of Midwifery & Women’s Health. https://doi.org/10.1111/jmwh.13083.

    Article  Google Scholar 

  • Baumeister, L., Marchi, K., Pearl, M., Williams, R., & Braveman, P. (2000). The validity of information on Race and Hispanic ethnicity in California Birth Certificate Data. Health Services Research, 35(4), 869–883.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Benchimol, E. I., Smeeth, L., Guttmann, A., Harron, K., Moher, D., Petersen, I., … Langan, S. M. (2015). The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLOS Medicine, 12(10), e1001885. https://doi.org/10.1371/journal.pmed.1001885.

  • Biscone, E. S., Cranmer, J., Lewitt, M., & Martyn, K. K. (2017). Are CNM-attended births in Texas hospitals underreported? Journal of Midwifery & Women’s Health, 62(5), 614–619. https://doi.org/10.1111/jmwh.12654.

    Article  Google Scholar 

  • Cahill, A. G., Stamilio, D. M., Odibo, A. O., Peipert, J., Stevens, E., & Macones, G. (2008). Racial disparity in the success and complications of vaginal birth after cesarean delivery. Obstetrics and Gynecology, 111(3), 654–658. https://doi.org/10.1097/AOG.0b013e318163be22.

    Article  PubMed  Google Scholar 

  • Center for Health Statistics. (2003). National Center for Health Statistics Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death National Vital Statistics System. Updated September 2019. Hyattsville, MD.

  • Cheng, E. R., Declercq, E. R., Belanoff, C., Iverson, R. E., & McCloskey, L. (2015). Racial and ethnic differences in the likelihood of vaginal birth after cesarean delivery. Birth, 42(3), 249–253. https://doi.org/10.1111/birt.12174.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cox, K. J., Bovbjerg, M. L., Cheyney, M., & Leeman, L. M. (2015). Planned home VBAC in the United States, 2004–2009: Outcomes, maternity care practices, and implications for shared decision making. Birth, 42(4), 299–308. https://doi.org/10.1111/birt.12188.

    Article  PubMed  Google Scholar 

  • Cross-Barnet, C., Hill, I., Dubay, L., Courtot, B., Benatar, S., Garrett, B., … Yousefian, C. (2018). Strong Start for Mothers and Newborns Evaluation: YEAR 5 PROJECT SYNTHESIS Vol. 1: Cross-Cutting Findings. Baltimore, MD: Centers for Medicare & Medicaid Services.

  • Cunningham, F. G., Bangdiwala, S. I., Brown, S. S., Dean, T. M., Frederiksen, M., Rowland Hogue, C. J., … Zimmet, S. C. (2010). National Institute of Health Consensus Development Conference statement: Vaginal birth after cesarean: New insights. March 8–10, 2010. Obstetrics and Gynecology, 115(6), 1279–1295. https://doi.org/10.1053/j.semperi.2010.06.002.

  • Curtin, S. C., Gregory, K. D., Korst, L. M., & Uddin, S. F. G. (2013). National Vital Statistics Reports Maternal Morbidity for Vaginal and Cesarean Deliveries, According to Previous Cesarean History: New Data From the Birth Certificate, 2013 (Vol. 64).

  • Declercq, E. R., Sakala, C., Corry, M. P., & Applebaum, S. (2006). Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences: New York: The Childbirth Connection. https://doi.org/10.1624/105812407X244769.

  • Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Risher, P. (2002). Listening to mothers: Report of the first national U.S. survey of women’s childbearing experiences. New York: Maternity Center Association.

  • Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Herrlich, A. (2014). Major survey findings of listening to mothers III: Pregnancy and birth. Journal of Perinatal Education, 23(1), 9–16. https://doi.org/10.1891/1058-1243.23.1.9.

    Article  Google Scholar 

  • DeFranco, E. A., Rampersad, R., Atkins, K. L., Odibo, A. O., Stevens, E. J., Peipert, J. F., … Macones, G. A. (2007). Do vaginal birth after cesarean outcomes differ based on hospital setting? American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2007.06.014.

  • Deline, J., Varnes-Epstein, L., Dresang, L. T., Gideonsen, M., Lynch, L., & Frey, J. J. (2012). Low primary cesarean rate and high VBAC rate with good outcomes in an Amish birthing center. Annals of Family Medicine, 10(6), 530–537. https://doi.org/10.1370/afm.1403.

    Article  PubMed  PubMed Central  Google Scholar 

  • Diamond-Brown, L. A. (2020). Women’s motivations for “choosing” unassisted childbirth: A compromise of ideals and structural barriers. Medicine Advances in Medical Sociology, 20, 85–106. https://doi.org/10.1108/S1057-629020190000020010.

    Article  Google Scholar 

  • Dietz, P., Bombard, J., Mulready-Ward, C., Gauthier, J., Sackoff, J., Brozicevic, P., … Farr, S. (2015). Validation of selected items on the 2003 U.S. standard certificate of live birth: New York City and Vermont. Public Health Reports, 130(1), 60–70. https://doi.org/10.1177/003335491513000108.

  • Dunsmoor-Su, R., Sammel, M., Stevens, E., Peipert, J. L., & Macones, G. (2003). Impact of sociodemographic and hospital factors on attempts at vaginal birth after cesarean delivery. Obstetrics & Gynecology, 102(6), 1358–1365. https://doi.org/10.1016/j.obstetgynecol.2003.08.010.

    Article  Google Scholar 

  • Ediger, M. (2005). Old order Amish philosophy of education. Education, 125(3), 422–425.

    Google Scholar 

  • Edmonds, J. K., Hawkins, S. S., & Cohen, B. B. (2016). Variation in vaginal birth after cesarean by maternal race and detailed ethnicity. Maternal and Child Health Journal, 20(6), 1114–1123. https://doi.org/10.1007/s10995-015-1897-5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Elizabeth, G., McVittie, C., & Magill, M. (2009). Birth choice following primary Caesarean section: Mothers’ perceptions of the influence of health professionals on decision-making. Journal of Reproductive and Infant Psychology, 27(1), 4–14. https://doi.org/10.1080/02646830801918430.

    Article  Google Scholar 

  • Grobman, W. A., Lai, Y., Landon, M. B., Spong, C. Y., Rouse, D. J., Varner, M. W., … Sorokin, Y. (2011). The change in the rate of vaginal birth after caesarean section. Paediatric and Perinatal Epidemiology, 25(1), 37–43. https://doi.org/10.1111/j.1365-3016.2010.01169.x.

  • Hollard, A. L., Wing, D. A., Chung, J. H., Rumney, P. J., Saul, L., Nageotte, M. P., & Lagrew, D. (2006). Ethnic disparity in the success of vaginal birth after cesarean delivery. The Journal of Maternal-Fetal & Neonatal Medicine, 19(8), 483–487. https://doi.org/10.1080/14767050600847809.

    Article  Google Scholar 

  • Homer, C. S., Besley, K., Bell, J., Davis, D., Adams, J., Porteous, A., & Foureur, M. (2013). Does continuity of care impact decision making in the next birth after a caesarean section (VBAC)? A randomised controlled trial. BMC Pregnancy and Childbirth, 13(1), 140. https://doi.org/10.1186/1471-2393-13-140.

    Article  PubMed  PubMed Central  Google Scholar 

  • Human Reproduction Programme at the World Health Organization. (2015). WHO Statement on Caesarean Section Rates (No. 15.02). Geneva: WHO. https://doi.org/10.1111/1471-0528.13526.

  • Kabir, A. A., Pridjian, G., Steinmann, W. C., Herrera, E. A., & Khan, M. M. (2005). Racial differences in cesareans: An analysis of U.S. 2001 national inpatient sample data. Obstetrics & Gynecology, 105(4), 710–718. https://doi.org/10.1097/01.AOG.0000154154.02581.ce.

    Article  Google Scholar 

  • Keedle, H., Schmied, V., Burns, E., & Dahlen, H. G. (2015). Women’s reasons for, and experiences of, choosing a homebirth following a caesarean section. BMC Pregnancy Childbirth, 15, 206. https://doi.org/10.1186/s12884-015-0639-4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Keith, T. (2015). Multiple regression and beyond: An introduction to multiple regression and structural equation modeling (3rd ed.). England, UK: Routledge.

    Google Scholar 

  • Kohn, L. (Ed.). (2004). Academic health centers: Leading change in the 21st century. Washington, DC: National Academies Press.

    Google Scholar 

  • Korst, L. M., Gregory, K. D., Fridman, M., & Phelan, J. P. (2011). Nonclinical factors affecting women’s access to trial of labor after cesarean delivery. Clinics in Perinatology, 38(2), 193–216. https://doi.org/10.1016/j.clp.2011.03.004.

    Article  PubMed  Google Scholar 

  • Kozhimannil, K. B., Shippee, T. P., Adegoke, O., & Virnig, B. A. (2013). Trends in hospital-based childbirth care: The role of health insurance. American Journal of Managed Care. https://doi.org/10.1097/MPG.0b013e3181a15ae8.Screening.

    Article  Google Scholar 

  • Leeman, L. M., Beagle, M., Espey, E., Ogburn, T., & Skipper, B. (2013). Diminishing availability of trial of labor after cesarean delivery in New Mexico hospitals. Obstetrics and Gynecology, 122, 242–247. https://doi.org/10.1097/AOG.0b013e31829bd0a0.

    Article  PubMed  Google Scholar 

  • Martin, J., Hamilton, B. E., Osterman, M. J. K., Driscoll, A. K., & Drake, P. (2018). Births: Final Data for 2017. National Vital Statistics Reports, 67(8), 1–50.

    PubMed  Google Scholar 

  • Martin, J., Wilson, E., Osterman, M., Saadi, E., Sutton, S., & Hamilton, B. (2013). National vital statistics reports assessing the quality of medical and health data from the 2003 birth certificate revision: Results from two States. Hyattsville, MD: NVSS.

    Google Scholar 

  • National Academies of Sciences, Engineering, and Medicine (2017). Communities in action: Pathways to health equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/24624.

  • National Academies of Sciences Engineering and Medicine. (2020). Birth settings in America: Outcomes, quality, access, and choice. Washington, DC: The National Academies Press. https://doi.org/10.17226/25636.

  • National Center for Health Statistics. (2004). Mother’s worksheet for child’s birth certificate. Hyattsville, MD: NCHS.

    Google Scholar 

  • National Center for Health Statistics. (2013). 2013 NCHS urban-rural classification scheme for counties series 2, Number 166. Hyattsville, MD: NCHS.

    Google Scholar 

  • National Center for Health Statistics. (2017). Data access—data user agreement. Retrieved May 10, 2017, from https://www.cdc.gov/nchs/data_access/restrictions.htm.

  • National Center for Health Statistics. (2018). User guide to the 2017 natality public use file. Hyattsville, MD: NCHS.

    Google Scholar 

  • NCHS. (2017). 2017 Natality Limited Geography, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Hyattsville, MD: NCHS.

  • Northam, S., & Knapp, T. R. (2006). The reliability and validity of birth certificates. JOGNN—Journal of Obstetric, Gynecologic, and Neonatal Nursing, 35(1), 3–12. https://doi.org/10.1111/j.1552-6909.2006.00016.x.

    Article  Google Scholar 

  • Office of Disease Prevention and Health Promotion. (2016). Maternal, Infant, and Child Health. Retrieved May 6, 2017, from https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives.

  • Osterman, M. J. K. (2020). Recent trends in vaginal birth after cesarean delivery : United States, 2016–2018; NCHS data brief no. 339. Hyattsville, MD: NCHS.

  • Plough, A. C., Galvin, G., Li, Z., Lipsitz, S. R., Alidina, S., Henrich, N. J., … Shah, N. T. (2017). Relationship between Labor and Delivery Unit Management Practices and Maternal Outcomes. Obstetrics and Gynecology, 130(2), 358–365. https://doi.org/10.1097/AOG.0000000000002128.

  • Rosenstein, M. G., Kuppermann, M., Gregorich, S. E., Cottrell, E. K., Caughey, A. B., & Cheng, Y. W. (2013). Association between vaginal birth after cesarean delivery and primary cesarean delivery rates. Obstetrics & Gynecology, 122(5), 1010–1017. https://doi.org/10.1097/AOG.0000000000001032.

    Article  Google Scholar 

  • Shorten, A., Shorten, B., & Kennedy, H. P. (2014). Complexities of choice after prior cesarean: A narrative analysis. Birth, 41(2), 178–184. https://doi.org/10.1111/birt.12082.

    Article  PubMed  Google Scholar 

  • Triebwasser, J. E., Kamdar, N. S., Langen, E. S., Moniz, M. H., Basu, T., Syrjamaki, J., … Morgan, D. M. (2019). Hospital contribution to variation in rates of vaginal birth after cesarean. Journal of Perinatology, 39(7), 904–910. https://doi.org/10.1038/s41372-019-0373-2.

  • U.S. Census Bureau. (2019). Census Regions and Divisions of the United States. Retrieved August 22, 2019, from https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf.

  • Ulmer, C., McFadden, B., & Nerenz, D. (Eds.). (2009). Race, ethnicity, and language data: Standardization for health care quality improvement. Washington, D.C.: National Academies Press. https://doi.org/10.17226/12696.

  • Vedam, S., Stoll, K., MacDorman, M., Declercq, E., Cramer, R., Cheyney, M., … Powell Kennedy, H. (2018). Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLoS ONE, 13(2), e0192523. https://doi.org/10.1371/journal.pone.0192523.

  • Vintzileos, A. M., Ananth, C. V., Smulian, J. C., Scorza, W. E., & Knuppel, R. A. (2002). The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions. American Journal of Obstetrics and Gynecology, 187(5), 1254–1257. https://doi.org/10.1067/mob.2002.127140.

    Article  PubMed  Google Scholar 

  • Yee, L. M., Liu, L. Y., & Grobman, W. A. (2017). Relationship between physician on-call schedule and VBAC success. American Journal of Obstetrics & Gynecology, 216(1), 75.e1–75.e6. https://doi.org/10.1016/j.ajog.2016.08.032.

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by Foundation for the National Institutes of Health (Grant No. T32NR008346).

Author information

Authors and Affiliations

  1. Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA

    Bridget Basile Ibrahim, Holly Powell Kennedy & Margaret L. Holland

Authors
  1. Bridget Basile Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Holly Powell Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margaret L. Holland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bridget Basile Ibrahim.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: The first two sentence in the second paragraph of the introduction section and table 3 are corrected.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Basile Ibrahim, B., Kennedy, H.P. & Holland, M.L. Demographic, Socioeconomic, Health Systems, and Geographic Factors Associated with Vaginal Birth After Cesarean: An Analysis of 2017 U.S. Birth Certificate Data. Matern Child Health J 25, 1069–1080 (2021). https://doi.org/10.1007/s10995-020-03066-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-020-03066-3

Keywords

Search

Navigation