Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study.

Yung-Hsiang Ying,Koyin Chang,George Linn

doi:10.3390/jcm8081203

Abstract

The rate of vaginal birth after cesarean section (VBAC) is extremely low in Taiwan probably due to the high perceived risk of trial of labor after a cesarean (TOLAC). To promote the benefits associated with vaginal birth, this study provides evidence to potentially assist relevant public authorities adopt appropriate guidelines or optimize health insurance reimbursement policies to achieve a higher VBAC rate. Employing the National Health Insurance (NHI) Claim Data, this study analyzes women’s adoptions of birth-giving methods for those who had previous cesarean section (CS) experiences. Empirical methods include logit, probit, and hierarchical regression models controlling women’s demographics, incentive indicators, as well as hospital and obstetrician characteristics. Taiwan continues to have a decreasing trend in VBAC rate even with an increase in NHI payment for vaginal birth delivery in 2005, which stimulated a surge in VBAC rate only temporarily. Factors that significantly influence women’s adoption of VBAC include institution-specific random effects, weekend admission, comorbidities during pregnancy, and income and fertility of women. Change in service payment from National Health Insurance (NHI) to healthcare providers constitutes an effective policy in directing clinical practices in the short term. Constant and systematic policy review should be undertaken to promote safe and beneficial medical practices. The results of the study suggest that women’s adoption of birth-giving method is dominated by non-medical considerations. Significant institution-specific effects imply that women might not be well-informed regarding their optimal birth-giving choice. Health education and training programs for hospital personnel should be kept up to date to better serve society.

Highlights

The proportion of women giving birth by cesarean section (CS) in Taiwan reached 37% in 2016, the second-highest globally after Italy at 39% [1,2]
The rate of vaginal birth after cesarean section (VBAC) is calculated for only women who had previous cesarean section (CS) experiences
Two plausible explanations for this phenomenon are: (1) since family members tend to be freer during the weekends, they give more support to the women to wait for vaginal birth than those who admitted during workdays; and (2) obstetricians may be more willing to try vaginal birth if labor has progressed for the cases of emergency delivery since there might be fewer supporting personnel on duty in the operation room during the weekends

Summary

Introduction

The proportion of women giving birth by cesarean section (CS) in Taiwan reached 37% in 2016, the second-highest globally after Italy at 39% [1,2]. [5] Relative to the vaginal birth after cesarean section (VBAC) rates of 8.5–30% in the U.S [6] and 30–50% in European countries, [7] Taiwan’s low rate of VBAC of only 1.5–4.0% in recent decades [8,9,10] implies that it is pervasive to view VBAC as a hazardous practice. Trial of labor after a cesarean (TOLAC) should be encouraged because there are major benefits associated with vaginal birth, such as more rapid recoveries, potentially fewer hazards in future pregnancies, [15,16,17] and less likelihood of childhood diseases, including asthma, obesity, and allergies [18,19]. The increasing rate of primary and repeat cesarean delivery is a topic of concern for many clinicians and patients

Objectives

Results

Discussion

Conclusion