American Journal of Epidemiology Vol. 147, No. 6: 581-586
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
Are We understanding Rates of Vaginal Birth after previous cesaren Birth? The validity of Delivery Methods from Birth Certificates
1World Health Organisation, Collaborating center in perinatal care and Health services research in maternal and Child Health, Divison of Reproductive Health, National Center for Chronic disease Prevention Public Health services, US Department of Health and Human Services Atlanta, GA
2Epidemic Inteligence service, Epdemilogy, Program Office, Centers for Disease Control and Prevention Atlanta GA
Reprint requests to Dr.Diane C.Green, The prudential center for Health Care Research, 2859 Paces Fery Road, Suite 820, Atlanta, GA 30339
Previous studies of birth certificates have not fully evaluated how accurately they identify delivery methods that have a historical component, such as repeat cesarean and vaginal birth after previous cesarean (VBAC). The authors used linked Georgia birth certificates for first and second deliveries to examine the accuracy of four reported delivery methods in the second pregnancy: vaginal (without previous cesarean), VBAC, primary cesarean, and repeat cesarean, as well as an indicator of a previous cesarean. From the immediate birth certificates, the delivery method for each of the two births was classified as vaginal (V) or cesarean section (CS), which produced possible sequences of V-V, CS-V, V-CS, and CS-CS. The delivery method for the second births to 106,049 women from 1989 through 1992 was reviewed, taking into account the historical information from the linked certificates regarding the first births. Only 42.0% of women with a CS-V sequence were correctly designated on the second birth certificate as a VBAC; 79.3% of women with a V- CS sequence were correctly designated as primary cesarean. From 1980 through 1988, birth certificates contained a check box indicating a previous cesarean (but no VBAC box). During this period, only 75.5% of 25,491 women with a previous cesarean were so designated on the birth certificate. These findings suggest that cross-sectional vital records data substantially underestimate VBAC and primary cesarean rates.
bias (epidemiology); birth certificates; cesarean section; esarean section; repeat; reproducibility of results; sensitivity and specificity; vaginal birth after cesarean
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