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Trials and Tribulations of Modern Day Childbirth: a Literature Analysis of Factors Contributing to the Recent Decline in Vaginal Birth After Cesarean Delivery

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Trials and Tribulations of Modern Day Childbirth: a Literature Analysis of Factors Contributing to the Recent Decline in Vaginal Birth After Cesarean Delivery The University of Maine DigitalCommons@UMaine Honors College Spring 2019 Trials and Tribulations of Modern Day Childbirth: A Literature Analysis of Factors Contributing to the Recent Decline in Vaginal Birth After Cesarean Delivery Camilla Horton University of Maine Follow this and additional works at: https://digitalcommons.library.umaine.edu/honors Part of the Biology Commons Recommended Citation Horton, Camilla, "Trials and Tribulations of Modern Day Childbirth: A Literature Analysis of Factors Contributing to the Recent Decline in Vaginal Birth After Cesarean Delivery" (2019). Honors College. 514. https://digitalcommons.library.umaine.edu/honors/514 This Honors Thesis is brought to you for free and open access by DigitalCommons@UMaine. It has been accepted for inclusion in Honors College by an authorized administrator of DigitalCommons@UMaine. For more information, please contact [email protected]. TRIALS AND TRIBULATIONS OF MODERN DAY CHILDBIRTH: A LITERATURE ANALYSIS OF FACTORS CONTRIBUTING TO THE RECENT DECLINE IN VAGINAL BIRTH AFTER CESAREAN DELIVERY AN HONORS THESIS by Camilla R. Horton A Thesis Submitted in Partial Fulfillment of the Requirements for a Degree with Honors (Biology) The Honors College University of Maine May 2019 Advisory Committee: Michelle Goody, Research Assistant Professor in the School of Biology and Ecology, Advisor Lynn Atkins, Instructor of Biology Jessica Miller, Professor of Philosophy Janice Pelletier, Pediatric Dermatologist for Northern Light Jennie Woodard, Lecturer in the Honors College © 2019 Camilla Horton All Rights Reserved ABSTRACT C-sections are an extremely common procedure in modern day America, and while there are serious indications for cesarean delivery including complications for mother and baby, there are likely far more cesareans performed each year than medically necessary. This A comprehensive literature analysis was compared to individual data collection from the Center for Disease Control and Prevention’s National Vital Statistics System. Both the analysis of the literature and the individual data collection confirmed that cesarean deliveries in the US have increased to from less than 10% in the 1970s, to over 30% in the years following 2005. Vaginal birth after cesarean delivery (VBAC) is an alternative option to elective repeat cesarean deliveries. The VBAC rate in the US has decreased since 1996 opposing the rise of cesarean deliveries. A review of the literature showed that this decline in VBAC is due to a lack of women attempting Trial of Labor After Cesarean (TOLAC). A decline in TOLAC is seen from 1995 to 2006. The rate of TOLAC success has remained constant over the past 30 years. This indicates that the reason for TOLAC decline is not a decline in success rates but rather due to other factors such as, maternal fear of labor, risks including uterine rupture or provider mentality, lack of training or concern for malpractice. ACKNOWLEDGEMENTS I would first like to thank my parents for always allowing me to explore my passions in life and giving me opportunities to grow as a student and as a person. You have given me the world and I hope you can see what that has meant to me. I would like to thank the University of Maine and the many amazing professors that change lives with their research and mentorship. I would like to extend my gratitude towards my committee members, Lynn Atkins, Jessica Miller, Janice Pelletier, and Jennie Woodard for their encouragement and flexibility throughout this journey. Your insight and wisdom in all subjects was invaluable. Finally, I would like to thank my advisor, Michelle Goody who worked tirelessly to help complete this project. Thank you for your willingness to teach, mentor and model what it means to be successful in research. You have taught me so many academic skills that I will not soon forget. iv TABLE OF CONTENTS PERSONAL INSPIRATION ........................................................................................... 1 INTRODUCTION ........................................................................................................... 3 Background ................................................................................................................. 3 Financial Considerations .......................................................................................... 3 Risks and Complications of Cesarean Deliveries ...................................................... 4 Indications for Cesarean Delivery ............................................................................ 6 Labor and Delivery Physiology and Failure to Progress ........................................... 8 Aim of This Study ................................................................................................. 11 METHODS ................................................................................................................... 13 Collection of Data from CDC Vital Statistics Online Data Portal ............................... 13 Literature Search Inclusionary and Exclusionary Criteria ........................................... 14 Literature on Cesarean Delivery and VBAC Rates Over Time ................................... 14 Literature on TOLAC Rates and Success Rates.......................................................... 15 Data Presentation and Analysis .................................................................................. 16 RESULTS ..................................................................................................................... 17 Cesarean Deliveries increased in the United States and Maine between 1996 and 2009 17 VBAC decreased in United States and Maine after 1996 ............................................ 19 TOLAC Rates Decline in the United States from 1995 to 2007 .................................. 23 TOLAC Success in the United States from 1998 to 2016 ........................................... 24 DISCUSSION ............................................................................................................... 27 Likely Factors Contributing to the Decline in Trial of Labor After Cesarean Delivery27 Maternal Mentality ................................................................................................ 27 Uterine Rupture ..................................................................................................... 28 Provider Mentality, Work-Life Balance, Training, and Malpractice History ........... 29 Sources of Error and Future Directions ...................................................................... 30 Conclusions ............................................................................................................... 31 SYNTHESIS ................................................................................................................. 33 REFERENCES .............................................................................................................. 34 APPENDICES .............................................................................................................. 38 v APPENDIX A: Maternal Mortality Rates in the US ....................................................... 39 APPENDIX B: Cesarean Delivery and VBAC Rates in the US...................................... 40 APPENDIX C: Fetal Presentations ................................................................................ 41 AUTHOR’S BIOGRAPHY ........................................................................................... 42 vi LIST OF FIGURES Figure 1: Rate of Cesarean Deliveries in the US from 1990 to 2015..…………..………18 Figure 2: Rate of Cesarean Deliveries in the US from 1990 to 2013 (Data from Literature Review)..………….……………….……………………19 Figure 3: Rate of VBAC Delivery in the US from 1990 to 2015…………..……………21 Figure 4: Rate of VBAC in the US from 1980 to 2015 (Data from Literature Review)….………...……………………………………22 Figure 5: Rates of TOLAC in the US from 1995 to 2007 (Data from Literature Review)……………….…...……………………………24 Figure 6: TOLAC Rates and Success Rates in the US from 1998 to 2016 (Data from Literature Review)...………………………………………………26 vii PERSONAL INSPIRATION In August of 2018, I attended a Medical Mission trip with a group based out of Portland, Maine called Partners for World Health (PWH). The group visited Uganda where we focused on prenatal healthcare for women in multiple different cities throughout the country. We conducted patient histories and were able to learn about many of the cultural differences regarding childbirth in a developing country. Gaining a greater understanding for this culture made me reflect on the fact that women have been giving birth for many generations, and it made me question why methods have changed so drastically in developed countries. During the months leading up to this trip, I had been working to develop a thesis topic. This trip sparked my interest in prenatal healthcare and obstetrics. I began researching maternal mortality by country. I had heard that the United States had one of the highest maternal mortality rates within the developed world, so I began exploring the reasons behind this. The American College of Obstetrics and Gynecology has stated that the United States is the “only industrialized nation with a rising maternal mortality rate, and between 2000 and 2014, there was a 26% increase in the maternal mortality rate” 1 (see Appendix A). Following Latin America and the Caribbean, North America has the highest cesarean delivery rate worldwide at 32% increasing
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