Do vaginal birth after cesarean outcomes differ based on hospital setting?

Emily A. DeFranco, Roxane Rampersad, Kristin L. Atkins, Anthony O. Odibo, Erika J. Stevens, Jeffrey F. Peipert, David M. Stamilio, George A. Macones

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Objective: The objective of the study was to test the null hypothesis that outcomes of vaginal birth after cesarean (VBAC) do not differ on the basis of the hospital setting. Study Design: The study was a retrospective cohort study of women who were offered VBAC in 17 hospitals from 1996 to 2000. VBAC attempts occurring in hospitals with and without obstetrics-gynecology residency programs were compared, as were outcomes from university and community hospitals. Bivariate and multivariate logistic regression analyses assessed the association between hospital setting and VBAC outcomes. Results: Of 25,065 women with 1 or more prior cesareans, the VBAC attempt rate was 56.1% at hospitals with obstetrics-gynecology residencies, 51.3% at hospitals without obstetrics-gynecology residencies, 61% at university hospitals, and 50.4% at community hospitals. The occurrence of failed VBAC, blood transfusion, or composite adverse outcome did not differ by hospital setting. There was a significant increase in the uterine rupture rate at community (1.2%) vs university hospitals (0.6%), but the absolute risk remained low. Conclusion: The rate of VBAC-associated complications is low, independent of hospital setting.

Original languageEnglish
Pages (from-to)400.e1-400.e6
JournalAmerican Journal of Obstetrics and Gynecology
Issue number4
StatePublished - Oct 2007


  • cesarean delivery
  • community hospital
  • residency program
  • university hospital
  • vaginal birth after cesarean

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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