| | Vaginal Birth after Cesarean Section
PURPOSE
To monitor the rates of vaginal birth after cesarean (VBAC).
BACKGROUND
In 2002, a total of 59,248 births were delivered in the United States by VBAC.(1) Vaginal birth after a previous cesarean has been shown to be an appropriate option for many women who would otherwise have been delivered by repeat cesarean. National trends show a steady increase in VBAC rate from 1991 until 1996 and then a 27% decline from 1996 until 2000. In 2001 the VBAC rate fell to 16.4% and in 2002 to 12.6%. This sharp decline may be related to reports of the risks associated with VBAC, more conservative practice guidelines, legal pressures as well as the continuing debate regarding the harm and benefits of vaginal birth versus cesarean section. Conversely, the U.S. cesarean rate increased for the sixth consecutive year to 26.1.(1) The medical community continues its debate as to the appropriate level for the cesarean rate and the role of VBAC deliveries in its reduction. “While it was once widely held that cesarean deliveries entailed more risk to the mother and baby than vaginal deliveries, this has been challenged recently, especially with regard to VBAC deliveries.” (2)
In July 2002, Gundersen Lutheran began sharing VBAC data with other JCAHO accredited hospitals through the Maryland Hospital Association’s Quality Indicator Project-Core Measure Component.
AIM
To exceed the national JCAHO benchmark for vaginal births after cesarean.
METHOD/MEASURES
The VBAC Rate is calculated by dividing the total number of VBACs by the number of women with history of prior cesarean delivery who delivered vaginally x 100. Excluded are patients who delivered via cesarean section and those with diagnosis of abortion.
Data were compared statistically using Pearson’s Chi Square.
BENCHMARK
JCAHO Quality Indicator Project – Core Measures National Comparison Group
RESULTS
CONCLUSIONS
Gundersen Lutheran's VBAC rate continues to be significantly better than the national benchmark
(p-values range from 0.000 to 0.027).
NEXT STEPS
Given the importance of a vaginal trial of labor for women with a history of delivering by cesarean in maintaining a low cesarean section rate, VBAC rates will continue to be monitored.
REFERENCES
(1) Centers for Disease Control and Prevention. National Center for Health Statistics. Births: Final Data for 2001. December 18, 2002. Online http://cdc.gov/hchs/data/nvsr/nvsr52/nvsr52_10.pdf
(2) Centers for Disease Control and Prevention. National Vital Statistics Reports. Trends in cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-99. 49 (13).
Online http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_13pdf
LEADER
Ted Peck, M.D.
ACKNOWLEDGEMENTS
Judy Weibel, RHIA, Clinical Systems and Data Services
Jane Robinson, RHIA, Quality and Performance Improvement
Michelle Mathiason, MS, Biostatistics
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