Effect of Early Prenatal Care Entry on Trial of Labor Rate and Vaginal Birth After Cesarean Section Rate Among Women with a Prior Cesarean Delivery: Georgia, United States (1999-2006) Open Access

Zertuche, Adrienne DeMarais (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/z316q243x?locale=en


Modes of delivery for women with a history of cesarean section include elective repeat cesarean delivery, successful trial of labor (TOL) leading to vaginal birth after cesarean section (VBAC), and unsuccessful trial of labor leading to repeat cesarean delivery. Maternal and perinatal outcomes differ for each delivery method, and likelihood of TOL success differs for each woman. Early access to prenatal care (PNC) provides time for in-depth counseling on these matters and is associated with improved overall pregnancy outcomes, but no data exist on the relationship between timing of PNC entry and rates of TOL and VBAC. Thus, we utilized Georgia's linked birth and hospital discharge records (1999 through 2006) to model the association between early initiation of PNC and rates of TOL and VBAC among singleton, second-order, live births at ≥20 weeks gestational age to women with a history of a primary cesarean section (n=48,048). Overall, TOL was documented for fewer than one-third of these women (32 percent) and only 8 percent delivered via VBAC. Women who accessed PNC early (prior to the fifth month of pregnancy) were only slightly more likely to have a documented TOL than women who accessed PNC late or not at all (crude RR 1.06 [95 percent confidence interval 1.00, 1.12]), and they were no more likely to deliver via VBAC (crude RR 0.92 [95 percent confidence interval 0.81, 1.04]). While early PNC may offer obstetric providers the opportunity to assess risk and advise patients about TOL, current counseling could be improved. Moreover, late entry into PNC should not be a barrier to engaging in discussion about TOL and VBAC.

Table of Contents

Chapter I: Literature Review 1

Chapter II: Manuscript 36

Title Page 37

Summary 38

Introduction 39

Methods 44

Results 48

Discussion 51

References 56

Box 1. 59

Table 1. 68

Table 2. 71

Table 3. 73

Table 4. 75

Chapter III: Summary 76

References 95


Figure 1. 99

Figure 2. 99


Appendix A. 100

Appendix B. 102

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