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Hospital contribution to variation in rates of vaginal birth after cesarean



To determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC).

Study design

This retrospective cohort study used claims data from Blue Cross and Blue Shield of Michigan. Women with a prior cesarean and a singleton livebirth between 2012 and 2016 were included. We calculated the hospital-specific risk-standardized VBAC rates and median odds ratio as a measure of variation.


Hospital-level adjusted rates varied nearly tenfold (3.7%–35.5%). Compared to the lowest volume hospitals (1st quartile), the likelihood of VBAC increased for those in the 2nd (adjusted OR 2.75 [95% CI 1.23–6.17]), 3rd (adjusted OR 3.73 [95% CI 1.59–8.75]), and 4th quartiles (adjusted OR 2.9 [95% CI 1.11–7.72]). The median OR suggested significant variation by hospital after adjustment.


The delivery hospital itself explains a large amount of the variation in rates of VBAC after adjustment for patient and hospital characteristics.

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Code availability

Risk and reliability-adjustment, median OR, and 80% interval OR available by request to corresponding author.


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Ms. Sarah Block assisted in preparation of this manuscript. Mr. Ryan Jakubowski assisted with graphic design for the figures.


Dr. Moniz receives support from the Agency for Healthcare Research and Quality (AHRQ) under award number K08 HS025465.

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Corresponding author

Correspondence to Jourdan E. Triebwasser.

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Conflict of interest

Dr. Langen, Dr. Moniz, Dr. Morgan, Mr. Kamdar, and Mr. Syrjamaki receive salary support from Blue Cross Blue Shield of Michigan (BCBSM). Mr. Kamdar is a consultant for Lucent Surgical. The other authors declare that they have no conflict of interest.

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Triebwasser, J.E., Kamdar, N.S., Langen, E.S. et al. Hospital contribution to variation in rates of vaginal birth after cesarean. J Perinatol 39, 904–910 (2019).

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