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Analyzing State and County Rates of Vaginal Birth after Cesarean (VBAC) before and after Revision of ACOG Guidelines
Methods: NCHS national birth certificate data was used. Mode of delivery was assessed at the state and country level for 2009 and 2011. Adjustments were made to account for the number of states that had adopted the 2003 revision to the Standard Certificate of a Live Birth. The 40 states (12 retaining the pre-2003 certificate and 28 with the 2003 revision) which didn’t change their birth certificate between 2009-2011 are the focus of the analysis. Multivariate analysis assesses the extent of change 2009-2011 controlling for state economic and health characteristics.
Results: Preliminary analysis found 37 of the 40 states experienced an increase from 2009-2011, though the increase was < 2 percentage points in 33 states. Delaware experienced the largest increase (8% to 12%). States reported wide variation in VBAC rates in 2011. Colorado (19.6%) and Utah (19.0%) reported the highest rates with Alabama (3.5%) and Mississippi (2.8%) the lowest. Greater variation was seen at the county level in 2011 with St. Louis, MO (35%) and Sante Fe, NM (33%) reporting the highest VBAC rates with 29 counties less than 3%.
Conclusion: Almost all states reported a slight increase in VBAC rates after the new guidelines, though there was wide variation across states and counties.
Learning Areas:
Public health or related laws, regulations, standards, or guidelinesPublic health or related organizational policy, standards, or other guidelines
Public health or related research
Learning Objectives:
Describe changes in VBAC clinical guidelines released by ACOG in 2010.
Explain national, state and county trends in VBAC rates.
Describe regional patterns in overall rates and changes in rates before and after revision of ACOG guidelines.
Keyword(s): Birth Outcomes, Maternal and Child Health
Qualified on the content I am responsible for because: I am a Maternal and Child Health Fellow at Boston University School of Public Health. I have studied vaginal birth after cesarean extensively in my academic career. I am working in collaboration with one of the field's most respected childbirth researchers, Dr. Eugene Declercq.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.