FACTORS INFLUENCING THE PRACTICE OF VAGINAL BIRTH AFTER CESAREAN-SECTION

Objectives. Vaginal birth after cesarean has been recommended for most women with previous cesarean sections for the past 10 years. This pra ctice, however, has not yet been generalized because high variations c an still be observed among countries, hospitals, and physicians. Metho ds. A case-control study involving 635 case patients and 2593 control patients was carried out to determine which characteristics of the phy sician, the patient, or the hospital were important in the adoption of this practice. Results. The results of the multiple stepwise logistic regression analysis indicate a higher likelihood that women will expe rience vaginal birth after cesarean if their physicians had cesarean r ates under 20%, had less than 5% of their patients considered at risk, and were younger than 54 years old. Vaginal birth after cesarean was also favored by hospitals characterized by a high degree of neonatal a nd obstetrical specialization, and a patient population with a low lev el of education. Conclusions. This policy is still in the developmenta l stage, as evidenced by the great variability between hospitals and p hysicians in rates of vaginal birth after cesarean. Further efforts ar e required for this policy to become the norm.