Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA.
Matern Child Health J. 2021 Jul;25(7):1069-1080. doi: 10.1007/s10995-020-03066-3. Epub 2020 Nov 17.
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.
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).
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.
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.
为了更好地了解美国目前剖宫产术后阴道分娩（VBAC）的比率，利用 2017 年美国出生证明数据，对与 VBAC 结局相关的社会人口学和地理因素进行了研究。
利用 2017 年有限地理数据集和分块序贯逻辑回归，对 2017 年在美国有 1 次或 2 次剖宫产史的妇女的后续分娩的社会人口学和地理因素进行了研究（N=540711）。
与白人妇女相比，黑人妇女（调整后的比值比[aOR]为 1.06；95%置信区间[CI]：1.04，1.08）和美国印第安人/阿拉斯加原住民妇女（aOR 为 1.18；95%CI：1.10，1.27）的 VBAC 几率高 6%和 18%。与有剖宫产史的白人妇女相比，亚裔/太平洋岛民妇女的 VBAC 几率低 9%（aOR 为 0.91；95%CI：0.88，0.94）。与非拉丁裔妇女相比，拉丁裔妇女的 VBAC 几率低 10%（aOR 为 0.90；95%CI：0.88，0.92）。接受过高中（aOR 为 0.85；95%CI：0.83，0.88）或大专（aOR 为 0.85；95%CI：0.84，0.87）教育的妇女比接受过本科及以上教育的妇女进行 VBAC 的可能性低。与有私人保险的妇女相比，由医疗补助支付分娩费用的妇女 VBAC 的可能性增加 5%（aOR 为 1.05；95%CI：1.03，1.07）。与有私人保险的妇女相比，自费的妇女 VBAC 的可能性增加了一倍（aOR 为 1.99；95%CI：1.92，2.07）。与美国东北部的妇女相比，南部各州（aOR 为 0.72；95%CI：0.71，0.74）出生的妇女 VBAC 的调整几率最低，中西部（aOR 为 1.19；95%CI：1.16，1.22）出生的妇女 VBAC 的调整几率最高。13%（13%）的 VBAC 妇女有认证的注册助产士（CNM）分娩助手，这比全国 CNM 分娩率高 44%。
VBAC 率存在显著差异，这与许多社会人口学和地理因素有关，可能反映了在获得剖宫产术后阴道分娩方面的差异以及对剖宫产术后分娩方式的偏好差异。建议进一步研究，以更好地了解和解决这些差异，以改善产妇护理。
