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Thursday, October 24, 2013

Trailers (63): Association between VBAC rate and primary cesarean delivery rate

Rosenstein, et al. Association between vaginal birth after cesarean delivery and primary cesarean delivery rates

Why should you read about this topic?

Everyone knows that the cesarean delivery rate is too high.  Understanding why it is high and what to do about it is a completely different story.

What were the authors trying to do?

Determine whether there is an association between the VBAC rate and the primary cesarean delivery rate

Who participated and in what setting?

Women (N=200,336) with term singleton births in California at sites with at least 50 deliveries in 2009

What was the study design?

Cross-sectional, retrospective cohort study

What were the main outcome measures?

Low-risk nulliparous term singleton vertex cesarean delivery rate

What were the results?

For every percentage point increase in VBAC rate, the hospitals’ primary cesarean delivery rate decreased by 0.65%

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: thoughtful selection of covariates.   Weaknesses: administrative database and birth certificate data.

What does the study contribute for your practice?

Hospitals with higher VBAC rates have lower primary cesarean delivery rates among low-risk nulliparous women with a singleton in vertex presentation at term