The relationship of health care delivery system characteristics and legal factors to mode of delivery in women with prior cesarean section: a systematic review

Kraemer, Dale F.; Berlin, Michelle; Guise, Jeanne-Marie

doi:10.1016/j.whi.2004.04.002

« PreviousWomen's Health Issues
Volume 14, Issue 3 , Pages 94-103, May 2004

The relationship of health care delivery system characteristics and legal factors to mode of delivery in women with prior cesarean section: a systematic review

Dale F. Kraemer, PhD
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Correspondence to: Dale F. Kraemer, PhD, Departments of Medical Informatics & Clinical Epidemiology and Public Health & Preventive Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Mailcode: BICC, Portland, OR 97239-3098, USA.
Michelle Berlin, MD, MPH
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Evidence-Based Practice Center, Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
Jeanne-Marie Guise, MD, MPH
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Evidence-Based Practice Center, Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA

Received 6 August 2003; received in revised form 20 February 2004; accepted 8 April 2004.

Abstract

Objective

To evaluate the relationship of health care delivery system characteristics and legal factors to mode of delivery in women with prior cesarean section.

Methods

We identified relevant studies by searching MEDLINE and HealthSTAR (1980 to May 2002), reference lists of pertinent articles, and recommendations of local and national experts. We also searched the online Cochrane systematic reviews and controlled trials registries, Database of Abstracts and Reviews on Effectiveness, and EMBASE databases.

Results

Studies of guidelines suggested that opinion leaders influence provider behavior regarding repeat cesarean delivery versus trial of labor decisions. Studies of hospital and insurance characteristics provided inconsistent results. There was insufficient evidence to evaluate the relationship between provider characteristics and delivery outcomes. Legislation and liability-related factors effected limited change.

Conclusion

Studies of health care system characteristics and other factors focused primarily on rates of delivery modes (vaginal birth after cesarean or repeat cesarean delivery) rather than patient safety or health outcomes. Future studies must account for case mix, time trends, and other potential confounders, especially concerning associations of provider characteristics.