Skip to main content
SMFM 2024 Pregnancy Meeting Main banner
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Poster Icons
Foundation Awardee
Foundation Awardee
No Social Media
No Social Media
Back
Q&A

Operative Obstetrics

Poster Session 4

(1080) Provider-level disparities in delivery outcomes among patients with a history of Cesarean

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: The decision about whether to pursue a trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery (ERCD) requires assessment of risks and benefits prenatally [1]. Providers play a central role in this counseling process [2, 3]. However, the influence of provider-associated characteristics on delivery methods remains unclear [4]. These include specific provider type, practice setting, and patients’ cultural beliefs [5-11]. We aimed to address these knowledge gaps by analyzing the impact of provider-level differences on delivery choice and delivery outcome in a cohort of patients with a prior history of cesarean delivery (CD).

Study Design:

This was a retrospective cohort study of 1,661 deliveries between April 29, 2015 – April 29, 2020. Subjects were divided into either TOLAC or ERCD, and they either delivered a vaginal birth after Cesarean (VBAC) or a repeat CD. The primary outcomes were a cohort of delivery choice and delivery outcomes. Disparities in these outcomes were reviewed between different obstetric providers, examining proportional differences through Chi-squared tests. The delivering provider was determined from a breakdown of different providers delivering at the study site during the study period.

Results: There were significant proportional disparities between patients in the TOLAC and ERCD groups, as well as between patients in the VBAC and repeat CD groups. Specifically, patients with a provider specializing in midwifery were significantly more likely to undergo TOLAC and deliver by VBAC, while patients seeing an OBGYN in private practice were more likely to deliver by elective repeat CD (p < 0.001).

Conclusion:

Given the evidence of increased risk of morbidity with multiple CDs, examining factors that influence repeat CDs is critical. This study suggests that provider-level differences relating to specialty may be one such factor. These data also illuminate under-researched areas in which culture influences maternal and neonatal delivery outcomes. These findings help to guide future investigations to improve outcomes among patients with a history of CD.