Three essays on births after Cesarean section

The rate of Cesarean section (C-section) delivery in the U.S. has dramatically increased over the past decade, resulting in rising hospital costs in the U.S. This increase in C-section rate was coupled with an increase in the rate of repeat C-section and can be largely attributable to the concerns about the relative safety of vaginal birth after Cesarean (VBAC). This dissertation comprises three articles investigating the practice patterns and the outcomes of this procedure.;The first chapter investigated how physicians respond differently to new information based on the influence of malpractice pressure regarding performing VBACs. Results show that higher malpractice pressure may be incentives for physicians to uptake information and adopt low-risk practice style.;The second chapter determined whether birth outcomes changed as a result of changes in the pattern of birth after C-sections over time. Selected major maternal and neonatal adverse events were compared between repeat C-sections and VBACs. I find maternal and neonatal outcomes for births after a C-section significantly improved overtime along with the secular increase in repeat C-section rates. The increased adoption of repeat C-sections may have been driven in part by the observed lower maternal complication rates and lower neonatal mortality rates.;The third chapter examined temporal trends in variation in obstetric practice patterns focusing on primary and repeat Cesarean sections among hospitals over time. There is a statistically significant downward trend in the degree of cross-hospital variation in repeat Cesarean section rates, but no similar trend for variation in primary Cesarean section rates. Practice patterns for repeat C-section become less variable over time may be a result of the diffusion of national clinical guidelines.