(560) Vaginal Birth after Cesarean (VBAC): Achieving the Healthy People Nulliparous Term Singleton Vertex (NTSV) Goal

Objective:
Substantial variation in cesarean births among low-risk, first-time parturients emphasizes the need for quality improvement efforts to target safe reduction in NTSV cesarean births. We sought to evaluate whether hospital achievement of the Healthy People 2030 NTSV goal (≤23.6%) was associated with a hospital having a VBAC policy in the United States.

Study

Design:
We conducted a cross sectional cohort study analysis using 2024 Leapfrog hospital survey data on NTSV cesarean rates at 1655 participating hospitals. Data was extracted from survey responses using filters for maternity care 'services' and achievement of the Healthy People 2030 'standard' to tabulate reported information for further analysis. Each hospital was categorized as 'VBAC supportive' or 'VBAC restrictive', and as 'meeting the standard' or 'not meeting the standard' for the Healthy People 2030 NTSV goal. Achievement of the Healthy People 2030 NTSV goal was compared between the groups. Statistical analysis was performed using Chi-square test as appropriate.

Results:
Mean NTSV cesarean delivery rate was 25.3% across all reporting maternal care facilities (n=1655), with 84.1% having in place a VBAC supportive policy. 41.1% of all reporting hospitals met the Healthy People NTSV goal. When evaluating progress towards meeting the NTSV goal, categorized by 'VBAC supportive' or 'VBAC restrictive', 39.3% of 'VBAC supportive' hospitals (n=1392) and 49.1% of 'VBAC restrictive' hospitals (n=263) meet the Healthy People 2030 NTSV goal of < 23.6% (p < .01).

Conclusion:
Hospitals with VBAC-supportive policies were less likely to meet the target NTSV cesarean rate of ≤23.6%, compared to VBAC restrictive hospitals. These findings suggest that other factors contributing to the practice environment may have a more considerable impact on NTSV outcomes than VBAC policy alone.