Objective: To determine which factors influence a trial of labor after previous cesarean delivery.
Methods: Among 8829 deliveries at five participating hospitals, the charts of 1001 women who had a previous cesarean delivery were reviewed to determine whether a trial of labor or elective cesarean had been performed. Bivariate analysis compared demographic factors, and logistic regression adjusted for other possible influential variables.
Results: Fifty-eight percent of the women underwent a trial of labor. Although obstetric variables did not differ between the groups, those undergoing a trial of labor were significantly more likely to be younger, non-white, unmarried, to have no one in the household employed, and to lack private insurance. When logistic regression was performed, only the site of care (odds ratio 0.36-0.52 depending on the site;P< .05) and private insurance (odds ratio 0.52,P< .0001) were independent predictors of a trial of labor.
Conclusion: Local factors and insurance status are important in determining whether a woman receives a trial of labor or elective cesarean delivery. These issues must be addressed if reduction of the national cesarean rate is to be realized.(Obstet Gynecol 1994;83:741-4)
The authors thank the following individuals and sites for their assistance and cooperation in gathering the data for this study: St. Claire Medical Center, Morehead, KY—Matthew A. Stiles, MD; East Carolina University/Pitt Memorial Hospital, Greenville, NC—Christopher Mansfield, PhD, and Dana King, MD; Sioux Falls Family Practice and McKennan Hospital, Sioux Falls, SD—Richard R. McClaflin, MD; FamilyCare Southeast and St. Mary's Hospital, Grand Rapids, MI—James A. Applegate, MD; St. Clare's Family Practice Residency and St. Clare's Hospital, Schenectady, NY—W. J. Duke Dufresne, MD, and Terry Viola, MD.
© 1994 The American College of Obstetricians and Gynecologists