Center for Health Statistics
Texas Health Care Information Collection
Utilization Review: Specific Inpatient Procedures by Texas Hospital Referral Region, 2010
A Vaginal Birth after Cesarean (VBAC) is when a mother, who has had a previous baby by cesarean section (C-section), gives birth to a subsequent baby vaginally. VBAC is considered appropriate for women whose previous C-section was performed with a "low-transverse" incision (sometimes called a 'bikini incision'). In order to have a VBAC, the woman must be delivering one baby only and it must be in the optimal position for delivery. This measure presents the number of vaginal births per 100 deliveries in women with previous Cesarean delivery and with no complicating factors.
Why is this measure important?
Women who have C-sections undergo major abdominal surgery and it takes much longer to recover from the birth than for a woman who delivers her baby vaginally. Accordingly, current medical practice aims to encourage woment to deliver their babies vaginally if it is clinically safe to do so. Also, there are greater risks to the patient, such as a higher risk of contracting a hospital-acquired infection, if they undergo major surgery. In addition, cesareans are more expensive than vaginal deliveries.
Why might there be variation?
Women must have had a low-transverse incision, as opposed to a lateral incision, of her abdomen in a previous C-section in order to be eligible for a VBAC procedure in a subsequent pregnancy. Therefore, historical and geographical variations in the way in which the first cesarean was performed will have an effect on the VBAC rate for subsequent pregnancies. In addition, institutions that serve as referral centers may experience large numbers of high-risk deliveries which require C-sections, but other less-well defined factors, such as patient preference, may also produce variation in the utilization of this procedure. This measure should be used in conjunction with other information to assess whether a rate is truly too high or too low.
What does this measure tell us?
The graphs and tables in this section show:
These measures are calculated by analyzing deliveries by women who previously delivered by cesarean section. The numerator and the denominator do not include cases where there was an abnormal presentation (e.g., the baby was in the breech position), the baby was delivered pre-term, it died or there was more than one. VBAC has been identified as a potentially under-used procedure. As such, higher rates may represent better quality.