O&G open
Hospital Variation in Labor After Cesarean and Vaginal Birth After Cesarean in Massachusetts, 2012-2022
By Attanasio LB, Kim S, Laws H and 2 others.
Abstract
Objective
To examine variation in labor after cesarean and vaginal birth after cesarean (VBAC) across hospitals and to assess the role of hospital characteristics in explaining this variation.
Methods
This was a retrospective cohort study using data from the Massachusetts Pregnancy to Early Life Longitudinal Data System from 2012 to 2022; hospital characteristics were constructed with data from the Massachusetts Center for Healthcare Information and Analytics and the Neonatology Solutions NICU Directory. The sample included 80,094 births to individuals 18 years of age or older with one prior cesarean and a singleton birth at 34-42 weeks without a clear contraindication to vaginal birth. Outcomes were labor after cesarean and VBAC among those with labor after cesarean. For each outcome, we estimated three multilevel logistic regression models with a random intercept for hospital: Model 1 was an empty model without covariates; model 2 added individual characteristics; and model 3 added hospital characteristics to Model 2.
