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

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...

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Detalles Bibliográficos
Autores principales: Ying, Yung-Hsiang, Linn, George, Chang, Koyin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722574/
https://www.ncbi.nlm.nih.gov/pubmed/31408987
http://dx.doi.org/10.3390/jcm8081203
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author Ying, Yung-Hsiang
Linn, George
Chang, Koyin
author_facet Ying, Yung-Hsiang
Linn, George
Chang, Koyin
author_sort Ying, Yung-Hsiang
collection PubMed
description 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.
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spelling pubmed-67225742019-09-10 Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study Ying, Yung-Hsiang Linn, George Chang, Koyin J Clin Med Article 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. MDPI 2019-08-12 /pmc/articles/PMC6722574/ /pubmed/31408987 http://dx.doi.org/10.3390/jcm8081203 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ying, Yung-Hsiang
Linn, George
Chang, Koyin
Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study
title Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study
title_full Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study
title_fullStr Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study
title_full_unstemmed Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study
title_short Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study
title_sort vaginal birth after cesarean section in taiwan: a population-based study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722574/
https://www.ncbi.nlm.nih.gov/pubmed/31408987
http://dx.doi.org/10.3390/jcm8081203
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