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Open AccessArticle

Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study

1
College of Management, National Taiwan Normal University, Taipei 116, Taiwan
2
Department of Obstetrics and Gynecology, Show Chwan Memorial Hospital, Changhua City 500, Taiwan
3
Department of Healthcare Information and Management, Ming Chuan University, Taoyuan 333, Taiwan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(8), 1203; https://doi.org/10.3390/jcm8081203
Received: 20 June 2019 / Revised: 29 July 2019 / Accepted: 6 August 2019 / Published: 12 August 2019
(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)
The rate of vaginal birth after cesarean section (VBAC) is extremely low in Taiwan probably due to the high perceived risk of trial of labor after a cesarean (TOLAC). To promote the benefits associated with vaginal birth, this study provides evidence to potentially assist relevant public authorities adopt appropriate guidelines or optimize health insurance reimbursement policies to achieve a higher VBAC rate. Employing the National Health Insurance (NHI) Claim Data, this study analyzes women’s adoptions of birth-giving methods for those who had previous cesarean section (CS) experiences. Empirical methods include logit, probit, and hierarchical regression models controlling women’s demographics, incentive indicators, as well as hospital and obstetrician characteristics. Taiwan continues to have a decreasing trend in VBAC rate even with an increase in NHI payment for vaginal birth delivery in 2005, which stimulated a surge in VBAC rate only temporarily. Factors that significantly influence women’s adoption of VBAC include institution-specific random effects, weekend admission, comorbidities during pregnancy, and income and fertility of women. Change in service payment from National Health Insurance (NHI) to healthcare providers constitutes an effective policy in directing clinical practices in the short term. Constant and systematic policy review should be undertaken to promote safe and beneficial medical practices. The results of the study suggest that women’s adoption of birth-giving method is dominated by non-medical considerations. Significant institution-specific effects imply that women might not be well-informed regarding their optimal birth-giving choice. Health education and training programs for hospital personnel should be kept up to date to better serve society. View Full-Text
Keywords: population-based study; hierarchical analysis; health policies; cesarean section population-based study; hierarchical analysis; health policies; cesarean section
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Ying, Y.-H.; Linn, G.; Chang, K. Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study. J. Clin. Med. 2019, 8, 1203.

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