Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts.
College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts.
J Womens Health (Larchmt). 2019 Sep;28(9):1302-1312. doi: 10.1089/jwh.2018.7270. Epub 2019 Mar 13.
Little is known about trial of labor after cesarean (TOLAC) uptake and vaginal birth after cesarean (VBAC) success on the national level, which is important as national-level data may help shape future clinical guidelines. This study examined correlates of trial of labor and successful VBAC among women with one prior cesarean in the United States in 2016. We used publically available birth certificate data for 2016. Outcomes were TOLAC among women with one prior cesarean ( = 338,311) and VBAC among women with a TOLAC ( = 76,688). We used logistic regression to assess the association between the outcomes and the following categories of independent variables: social determinants of health, demographic and medical factors impacting birth, behavioral factors, and geographic access. About 23% of women had a TOLAC, and 74% of women with a TOLAC gave birth vaginally. Black women had higher odds of TOLAC relative to White women, but lower odds of successful VBAC. Women without a high school degree had higher odds of TOLAC and of successful VBAC compared to women who completed high school or beyond, as did women with inadequate prenatal care utilization. Understanding correlates of TOLAC and successful VBAC at the population level is important for developing national guidelines that can be considered and individualized at the patient/provider level.
关于全国范围内剖宫产后经阴道分娩（TOLAC）的尝试和剖宫产后阴道分娩（VBAC）的成功率知之甚少，这一点很重要，因为国家级数据可能有助于制定未来的临床指南。本研究调查了 2016 年美国有一次剖宫产史的女性尝试 TOLAC 和 VBAC 成功的相关因素。我们使用了 2016 年公开的出生证明数据。结局是有一次剖宫产史的女性进行 TOLAC（ = 338,311）和有 TOLAC 的女性进行 VBAC（ = 76,688）。我们使用逻辑回归评估了结局与以下独立变量类别的关联：健康的社会决定因素、影响分娩的人口统计学和医疗因素、行为因素以及地理可及性。约 23%的女性进行了 TOLAC，74%的 TOLAC 女性进行了阴道分娩。黑人女性尝试 TOLAC 的几率高于白人女性，但 VBAC 成功的几率较低。未完成高中学业的女性尝试 TOLAC 和 VBAC 的几率均高于完成高中学业或更高学历的女性，接受产前保健不足的女性也是如此。了解人口水平上 TOLAC 和 VBAC 成功的相关因素对于制定国家级指南很重要，这些指南可以在患者/提供者层面进行考虑和个体化。
