CDC: VBAC rates increasing

Rates of vaginal birth after cesarean (VBAC) in the United States are on the rise, but the Healthy People 2020 goal for the marker-18.3%-isn’t likely to be reached for another 10 years, according to a new report from the Centers for Disease Control and Prevention (CDC).

The analysis is based on information amassed in the National Vital Statistics System about VBAC from 2016 to 2018. In 2016, all reporting areas implemented the 2003 revision to the U.S. Standard Certificate of Live Birth, marking the first time since 2004 that VBAC were available.

Year over year, VBAC rates overall in the United States increased from 12.4% to 12.8% to 13.3%, in 2016, 2017 and 2018, respectively. During that period, rates in women aged 20 to 29 rose from 12.7% to 13.6% and for women aged 30 to 39, they rose from 12.4% to 13.3%.

Looking at trends by race and Hispanic origin, the authors found that Native Hawaiian and Other Pacific Islander women were the only groups that did not see increases in VBAC during the report period. Non-Hispanic American Indian and Alaska Native women had the greatest increases, at 11%, compared with 10% for Hispanic women, and 5% for non-Hispanic white, non-Hispanic black, and non-Hispanic Asian women.

Considering trends associated with geographic, only one state-Wisconsin-had significantly lower VBAC rates in 2018 (19.2%) versus 2016 (20.5%). Twelve states had nonsignificant declines, whereas 20 states and the District of Columbia had increases that were not statistically significant. In contrast, in 17 states, VBAC rates increased. The four states with increases of more than 20% over time were Arkansas, California, Florida, and New Hampshire.

Variations also were seen in rates of VBAC by gestational age at birth. They increased 5% to 13% among births delivered at 38, 39, 40 and 41 or more weeks of gestations. VBAC was less likely to occur with births delivered at < 28 weeks in 2018 (26.4%) than in 2018 (27.9%) but the trend was not significant.