Variation in vaginal breech delivery rates by hospital type

Objective: To relate vaginal breech delivery rates to the following hospita l types: public, health maintenance organization, private teaching, or priv ate nonteaching. Methods: In a retrospective study using administrative discharge data from Los Angeles County, California, we calculated the vaginal breech delivery r ates of singleton breech deliveries during calendar years 1988 and 1991. Results: Ten thousand four hundred breech deliveries were identified, 8988 (86.4%) term and 1412 (13.6%) preterm. Twelve percent (1252 of 10,400) were vaginal deliveries (10.1% term and 24.5% preterm). Term vaginal breech del iveries varied by hospital type and were more frequent in public hospitals (28.4%, 95% confidence interval [CI] 26.1%, 30.7%) and less frequent in pri vate nonteaching hospitals (5.4%, 95% CI 4.8%, 5.9%). Term vaginal deliveri es were 2.4 to 11.3 times more likely among black women and 1.3 to 6.3 time s more likely for Hispanic women across all hospital types, compared with w hite women in private nonteaching hospitals. There was no difference in the proportion of preterm vaginal breech deliveries by hospital type (mean 24. 5%). However, with the exception of public hospitals, the proportion of vag inal breech deliveries for both term and preterm deliveries varied signific antly by ethnicity. Conclusion: The use of vaginal breech delivery varied by hospital type and patient ethnicity. Within private teaching and nonteaching hospitals, vagin al breech delivery was more likely for black women than far women of other ethnic groups. Further study is needed to understand the hospital policies or organizational factors, as well as the patient-related sociocultural and clinical factors, that contribute to those differences. The American Colle ge of Obstetricians and Gynecologists.