The following is a summary of “Examining Provider Practice-level Disparities in Delivery Outcomes among Patients with a History of Cesarean Delivery,” published in the April 2024 issue of Obstetrics and Gynaecology by McCarthy et al.

Opting for a trial of labor after cesarean (TOLAC) versus a scheduled repeat cesarean delivery (SRCD) necessitates a comprehensive assessment of risks and benefits during prenatal care, where both healthcare providers and patients assume pivotal roles. Nonetheless, the potential impact of provider-associated characteristics on delivery methods remains uncertain. In this retrospective cohort study spanning deliveries from April 29, 2015, to April 29, 2020, researchers sought to elucidate the influence of provider practice groups on obstetric outcomes among patients with a history of one prior cesarean delivery (CD).

Dividing subjects into three cohorts—SRCD, successful vaginal birth after cesarean (VBAC), and unsuccessful VBAC (comprising patients opting for TOLAC but ending with a CD)—the study group scrutinized disparities across five distinct obstetric provider practice groups operational at the study site during the study period. Through proportional differences analysis employing Chi-squared tests and logistic regression models, the investigators identified significant variations among the cohorts, with patients managed by Group D demonstrating a heightened likelihood of successful VBAC. At the same time, those under the care of Group A were more inclined towards SRCD. 

Multivariate analysis revealed that patients affiliated with Group D exhibited substantially higher odds ratios of successful VBAC than Group A. In contrast, those under the purview of Group E evidenced significantly diminished odds of successful VBAC. These findings underscore an intriguing association between provider practice groups and delivery outcomes in patients with a history of one prior CD, thereby augmenting the understanding of the complex dynamics influencing patient choices during pregnancy and emphasizing the pivotal role of both patients and providers. Such insights pave the way for future research endeavors to optimize outcomes for individuals with a history of CD.

Source: bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-024-06458-3