Document Detail

Rates of successful vaginal delivery after cesarean for patients with private versus public insurance.
MedLine Citation:
PMID:  10685196     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To examine the effect of insurance status on method of delivery while controlling for clinical and sociodemographic characteristics of women delivering at a single medical center. STUDY DESIGN: Sociodemographic and clinical characteristics of 878 women, who delivered their infants between 1985 and 1991 at a university hospital, were analyzed. Women were included if their previous infant was delivered by cesarean section and if the current pregnancy was > or = 37 weeks' gestation at nonemergent delivery with insurance status clearly specified. The outcome of interest was the rate of successful vaginal births after cesarean (VBAC) delivery by insurance status. RESULTS: The trial of labor rate for the cohort, defined as the rate of VBAC or cesarean deliveries following labor, was 55%; 61% were vaginal deliveries. Significant differences with regard to insurance status and several maternal factors were noted between trial of labor and cesarean section--no labor groups. After controlling for potentially confounding variables, the Medicaid/indigent group was more likely than the privately insured group to undergo a trial of labor (odds ratio, 1.5; 95% confidence interval, 1.1 to 2.4). Of women who underwent a trial of labor, after controlling for other characteristics, the Medicaid/indigent group was more likely than the privately insured group to deliver vaginally (odds ratio, 1.9; 95% confidence interval, 1.1 to 3.2). CONCLUSION: After controlling for other covariables, women with a history of a prior cesarean section with Medicaid/indigent insurance were more likely than privately insured women to attempt a trial of labor, and subsequently, to deliver vaginally, given that a trial of labor was attempted.
C L Wagner; A K Metts
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  19     ISSN:  0743-8346     ISO Abbreviation:  J Perinatol     Publication Date:  1999 Jan 
Date Detail:
Created Date:  2000-03-09     Completed Date:  2000-03-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  14-8     Citation Subset:  IM    
Children's Hospital, Department of Pediatrics, Medical University of South Carolina, Charleston 29425, USA.
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MeSH Terms
Hospitals, University
Insurance, Health*
Medical Indigency
New York
Trial of Labor
United States
Vaginal Birth after Cesarean / economics,  utilization*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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