Factors predicting elective repeat cesarean delivery.

Abstract

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. CONCLUSIONS: 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.