FACTORS PREDICTING ELECTIVE REPEAT CESAREAN DELIVERY

Objective: To determine which factors influence a trial of labor after previous cesarean delivery. Methods: Among 8829 deliveries at five pa rticipating hospitals, the charts of 1001 women who had a previous ces arean delivery were reviewed to determine whether a trial of labor or elective cesarean had been performed. Bivariate analysis compared demo graphic factors, and logistic regression adjusted for other possible i nfluential variables. Results: Fifty-eight percent of the women underw ent a trial of labor. Although obstetric variables did not differ betw een the groups, those undergoing a trial of labor were significantly m ore likely to be younger, non-white, unmarried, to have no one in the household employed, and to lack private insurance. When logistic regre ssion was performed, only the site of care (odds ratio 0.36-0.52 depen ding on the site; P < .05) and private insurance (odds ratio 0.52, P < .0001) were independent predictors of a trial of labor. Conclusion: L ocal factors and insurance status are important in determining whether a woman receives a trial of labor or elective cesarean delivery. Thes e issues must be addressed if reduction of the national cesarean rate is to be realized.