Vaginal Birth After Cesarean More Likely in Teaching Hospitals Versus Nonteaching Hospitals in Kentucky

INTRODUCTION: While it is a safe and cost-effective mode of birth in most instances, there are patient and hospital characteristics that impede access to vaginal birth after cesarean (VBAC) in a hospital setting. This study examined the extent to which variations in hospital-level VBAC rates were associated with patient and hospital characteristics. MATERIALS AND METHODS: We conducted a cross-sectional retrospective study using 2017-2022 hospital discharge data and hospital characteristics for 45 Kentucky labor and delivery hospitals with VBAC as the outcome. We calculated risk-adjusted average hospital-level VBAC rates over the study period. Using a mixed-effects logistic regression model with hospital random effects, we calculated unadjusted and adjusted odds ratios, and adjusted predicted probabilities of VBAC, adjusting for hospital and patient characteristics. Unadjusted and adjusted intraclass correlation coefficients assessed hospital contribution to variation in VBAC rates. RESULTS: Among 48,741 patients who gave birth after cesarean, 8.8% had a VBAC. Hospital-level VBAC rates ranged from .47% to 25.6%. Teaching hospital status was positively and significantly associated with VBAC (adjusted odds ratio: 2.73, 95% confidence interval [1.53, 4.86], p < .05). After adjusting for patient-level characteristics, no other hospital characteristics had a statistically significant association with VBAC. After adjusting for patient case mix, the delivery hospital accounted for 30% of the variation in VBAC rates. Less variation (11%) in VBAC rates was observed among teaching hospitals. CONCLUSIONS: Wide variation in hospital-level VBAC rates suggests that localized efforts focusing on intra-hospital factors such as hospital policies and provider behavior are an intervention point to increase VBAC access.