Predictors of attempted labor after cesarean
Faculty Mentor
Logan Cowan
Location
Russell Union Room 2075
Type of Research
On-going
Session Format
Oral Presentation
College
Jiann-Ping Hsu College of Public Health
Department
Epidemiology
Abstract
Background: Efforts to reduce cesarean delivery rates in low-risk pregnancies require understanding factors that influence whether labor is attempted prior to repeat cesarean delivery. In subsequent pregnancies after a prior cesarean, reducing unnecessary cesarean delivery depends on appropriate selection for a trial of labor (TOL). However, little is known about demographic, socioeconomic, and clinical characteristics associated with attempting labor among low-risk repeat cesarean births.
Methods: We conducted a cross-sectional study using the 2024 U.S. National Vital Statistics System (NVSS) Natality dataset, restricted to low-risk births resulting in repeat cesarean delivery. The primary outcome was attempted labor prior to cesarean delivery. Crude and adjusted odds ratios (ORs and aORs) with 95% confidence intervals (CIs) were estimated for maternal, paternal, and infant characteristics.
Results: After adjustment, odds of attempting labor declined with increasing maternal age (aOR 0.83, 95% CI 0.76–0.91 for 35–39 years; 0.80, 0.71–0.90 for ≥40 years vs < 24 years). Foreign-born patients had higher odds (1.15, 1.09–1.21), while foreign residence was associated with lower odds (0.59, 0.42–0.83). Compared with non-Hispanic White patients, higher odds were observed among non-Hispanic Black (1.41, 1.29–1.54), non-Hispanic Asian (1.17, 1.02–1.33), non-Hispanic >1 race (1.26, 1.12–1.43), and Hispanic patients (1.08, 1.01–1.16). Smoking during pregnancy (0.65, 0.56–0.75), class III obesity (0.78, 0.66–0.91), short interpregnancy interval (0.90, 0.85–0.94), late preterm birth (0.91, 0.85–0.97), and breech presentation (0.66, 0.60–0.72) were associated with lower odds. Higher odds were observed with post-term gestation (1.37, 1.27–1.47), male infants (1.10, 1.07–1.14), no prenatal care (1.38, 1.22–1.57), and frequent prenatal care (1.23, 1.17–1.30).
Conclusions: Distinct demographic and clinical factors influence whether patients attempt labor before repeat cesarean. Recognizing these patterns can guide equitable, targeted strategies to support appropriate trial of labor and reduce potentially avoidable repeat cesarean delivery.
Program Description
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Start Date
4-23-2026 1:45 PM
End Date
4-23-2026 2:00 PM
Recommended Citation
Edwards, Queeneth; Chopak-Foss, Joanne; Nwaonumah, Emmanuela Chioma; Guerette, Jessica; and Cowan, Logan, "Predictors of attempted labor after cesarean" (2026). GS4 Student Scholars Symposium. 136.
https://digitalcommons.georgiasouthern.edu/research_symposium/2026/2026/136
Predictors of attempted labor after cesarean
Russell Union Room 2075
Background: Efforts to reduce cesarean delivery rates in low-risk pregnancies require understanding factors that influence whether labor is attempted prior to repeat cesarean delivery. In subsequent pregnancies after a prior cesarean, reducing unnecessary cesarean delivery depends on appropriate selection for a trial of labor (TOL). However, little is known about demographic, socioeconomic, and clinical characteristics associated with attempting labor among low-risk repeat cesarean births.
Methods: We conducted a cross-sectional study using the 2024 U.S. National Vital Statistics System (NVSS) Natality dataset, restricted to low-risk births resulting in repeat cesarean delivery. The primary outcome was attempted labor prior to cesarean delivery. Crude and adjusted odds ratios (ORs and aORs) with 95% confidence intervals (CIs) were estimated for maternal, paternal, and infant characteristics.
Results: After adjustment, odds of attempting labor declined with increasing maternal age (aOR 0.83, 95% CI 0.76–0.91 for 35–39 years; 0.80, 0.71–0.90 for ≥40 years vs < 24 years). Foreign-born patients had higher odds (1.15, 1.09–1.21), while foreign residence was associated with lower odds (0.59, 0.42–0.83). Compared with non-Hispanic White patients, higher odds were observed among non-Hispanic Black (1.41, 1.29–1.54), non-Hispanic Asian (1.17, 1.02–1.33), non-Hispanic >1 race (1.26, 1.12–1.43), and Hispanic patients (1.08, 1.01–1.16). Smoking during pregnancy (0.65, 0.56–0.75), class III obesity (0.78, 0.66–0.91), short interpregnancy interval (0.90, 0.85–0.94), late preterm birth (0.91, 0.85–0.97), and breech presentation (0.66, 0.60–0.72) were associated with lower odds. Higher odds were observed with post-term gestation (1.37, 1.27–1.47), male infants (1.10, 1.07–1.14), no prenatal care (1.38, 1.22–1.57), and frequent prenatal care (1.23, 1.17–1.30).
Conclusions: Distinct demographic and clinical factors influence whether patients attempt labor before repeat cesarean. Recognizing these patterns can guide equitable, targeted strategies to support appropriate trial of labor and reduce potentially avoidable repeat cesarean delivery.
