Exploring Effect of Patient Counseling on Mode of Delivery After Cesarean Section [ID 2683575

Abstract

INTRODUCTION: Increasing vaginal birth after cesarean (VBAC) may help lower national cesarean delivery rates in the United States. This study aims to evaluate factors that affect counseling practices and trial of labor after cesarean (TOLAC). METHODS: All term repeat cesarean deliveries (rCDs) and VBACs from September 2018 to February 2020 were reviewed. Antepartum counseling on mode of delivery, demographic, and obstetrical data were collected. Patients who were not TOLAC candidates were excluded. This study was IRB approved. RESULTS: Six hundred thirty-five patients met inclusion criteria. 304 (47.72%) of these patients had rCD, 65 (10.20%) attempted TOLAC with subsequent rCD, and 268 (42.07%) had VBAC. Of the 635 patients, 470 (74.02%) patients had documentation of TOLAC counseling prior to admission for delivery, whereas 165 (25.98%) did not. TOLAC counseling documentation was not associated with age, race, ethnicity, body mass index (BMI), insurance type, or history of vaginal delivery (VD). Prior VBAC increased the odds of documented TOLAC counseling (odds ratio [OR] 2.36; 95% CI, 1.29–4.63). Medicaid insurance (OR 2.18; 95% CI, 1.29–3.73), history of VD (OR 2.28; 95% CI, 1.16–4.68), history of VBAC (OR 269.0; 95% CI, 50.2–5079), and documented TOLAC counseling (OR 21.12; 95% CI, 11.0–45.10) increased the odds of TOLAC. Increasing BMI decreased the odds of TOLAC (OR 0.91; 95% CI, 0.89–0.95). CONCLUSION: Documented TOLAC counseling increased the odds of attempting TOLAC. As only 74.02% of patients had documented counseling prior to admission for delivery, an effort to increase TOLAC counseling and documentation may increase TOLAC and subsequent VBAC rates, decreasing the cesarean delivery rate.