Vaginal birth after cesarean (VBAC) is a recommended delivery option for women with a history of one or two cesarean sections. Compared to repeat cesarean deliveries, VBAC is associated with better maternal and infant outcomes. Despite these benefits and national initiatives aimed at reducing unnecessary cesarean deliveries, VBAC rates remain low in the U.S. Research has shown that access to VBAC varies significantly by race, ethnicity, and socioeconomic status. This study aims to examine demographic, socioeconomic, and obstetric factors associated with VBAC in the U.S between 2019 and 2023 and assess whether these associations differ across race groups. A retrospective observational study was conducted using de-identified U.S. birth certificate data from the National Vital Statistics System (2019–2023). The study sample included 2,580,713 women with one or two prior cesarean deliveries, of whom 420,367 had a vaginal birth after cesarean. Sequential block logistic regression was performed for each year. Race-stratified analyses were conducted using the pooled 2019–2023 data to assess demographic, socioeconomic, and obstetric factors associated with VBAC. Increased maternal age, Hispanic ethnicity, private insurance, and lower educational attainment were generally associated with lower VBAC odds. Stratified analyses revealed significant within-group differences, including reversals in associations with maternal age and education across some race groups. VBAC rates modestly increased over the study period, though disparities remained. While VBAC is considered a beneficial delivery option, this study shows that it is not equitably utilized. These utilization gaps may point toward opportunities to increase national VBAC rates. VBAC is associated with improved maternal and infant outcomes compared to repeat cesarean delivery, but utilization in the U.S. remains low and inequitable. Using five years of national data, this study shows that although VBAC rates are increasing, disparities persist. Race-stratified analyses reveal within-group differences not seen in unstratified analyses, supporting the need for strategies to improve equitable access.
Rural birthing unit closures have raised concerns about access to prenatal care and maternal and infant outcomes. Iowa has experienced 41 closures since 2000, leaving a majority of counties without obstetric services. This study examines the impacts of these closures through a four-phase mixed-methods study conducted in partnership with Iowa State University, Iowa Department of Public Health, and Maternal, Infant, and Early Childhood Home Visiting. We replicated aggregate analyses used by state partners, then analyzed 681,187 individual birth records from 1999 to 2017 linked to county-level closure data. Hierarchical linear and logistic regression models estimated effects of closures on prenatal care and birth outcomes, stratified by maternal education, WIC receipt, and Medicaid coverage. We conducted qualitative interviews with 17 home visiting staff across eight counties impacted by closures and engaged partners in deliberating findings. Closures were associated with significant differences in prenatal care for mothers without a high school degree, including later initiation (0.30 months later when giving birth pre-closure, p < 0.05); fewer visits (1.53 fewer pre-closure, p < 0.05), and higher odds of inadequate prenatal care (OR = 5.7 pre-closure, p < 0.05). However, WIC and Medicaid buffered against these disruptions. Qualitative data highlighted increased travel burden, reduced choice, and weakened provider relationships. Closing rural birthing units disrupts prenatal care access, disproportionately affecting mothers without a high school degree. A cyclical, partnership-engaged approach using integrated data revealed impacts masked in aggregate analyses and offers a model for generating timely, actionable insights to guide rural maternal health policy and practice. Rural birthing unit closures have been linked to decreased access to obstetric services and adverse maternal and infant outcomes, yet much of the evidence relies on aggregate data and does not capture differential impacts across subpopulations. This study extends prior research by using individual-level linked data and qualitative insights to show that closures primarily disrupt prenatal care access, especially for mothers without a high school degree, while participation in WIC and Medicaid can buffer these effects. Findings underscore the value of integrated data and partnership-engaged research to guide timely, local responses to rural hospital closures.
Congenital syphilis cases in the U.S. have increased significantly over the past decade. The extent to which U.S. jurisdictions responded to the increases with changes in prenatal syphilis screening and enforcement policies and followed CDC sexually transmitted infection (STI) syphilis screening guidelines is unknown. CS and PS syphilis rates for U.S. jurisdictions (states and the District of Columbia) were obtained from the CDC. Prenatal syphilis screening requirements and enforcement policies were obtained from Nexis Uni or Westlaw. We used the Kruskal–Wallis rank-sum test to evaluate the relationship between the percent change in CS and PS syphilis rates (2013–2023) and 2021 CDC guideline compliance. CS and PS syphilis rates rose from 2013 to 2023. From 2016 to 2023, 15.7
To study home visiting programs augmented with relationship education addressing maternal depression (MD), substance use (SU), and self-harm ideation (SHI). We performed a secondary data analysis of a three-wave longitudinal randomized controlled trial of the Nurse-Family Partnership (NFP) program. In Oregon, 238 low-income, first-time pregnant mothers were randomized to a standard or augmented program where trained nurses integrated the Within My Reach curriculum and intimate partner violence screening and referral with the NFP workflow one-on-one at home visits. Nurses maintained good fidelity in the augmented program, tailored training to clients’ immediate needs, and were advised not to share with the staff in the standard program. At pregnancy, 1-year, and 2-year follow-ups, research assistants interviewed mothers with the Edinburgh Postnatal Depression Scale (including an SHI item), Alcohol Use Disorder Identification Test, and Drug Abuse Screening Test. Multilevel models and generalized estimating equations with the wave-intervention interactions were performed for MD, SHI, and SU, adjusting for race/ethnicity, age, education level, and nativity status. Depressive symptoms (25
To evaluate the factorial validity of the 35-item Children’s Eating Behavior Questionnaire (CEBQ) among Samoan children and assess whether empirically derived subscales were associated with weight status. Caregivers of n = 400 children aged 5–11 years in the ongoing Ola Tuputupua’e cohort study completed the CEBQ. We tested the original eight-factor structure using confirmatory factor analysis. Because model fit was poor, we conducted exploratory factor analysis and used multinomial logistic regression to examine associations between derived subscales and child weight status. The original CEBQ structure fit poorly (chi-square/df = 3.53, CFI = 0.654, TLI = 0.613, RMSEA = 0.080). EFA identified a 14-item, three-factor solution: Enjoyment of Food, Emotional Undereating, and Emotional Overeating. Compared with children in the lowest Enjoyment of Food tertile, those in the second and third tertiles had higher adjusted odds of obesity (aOR = 4.59, 95
