794: Comparison of neonatal neurologic injury with forceps, vacuum and cesarean delivery

Hospital characteristics analyzed included volume, geographic location, percent of patients with at least some college education, and percent of patients on public insurance. We included a hospital level variable indicating whether there were certified nurse midwives on (CNMs) on staff, with data obtained via telephone survey. We restricted the sample to hospitals open continuously from 1997-2006. RESULTS: Among 222 hospitals, 46% did not allow VBAC. Lower volume and rural location were associated with VBAC bans (73% of the smallest vs. 15% of the largest and 83% of rural vs. 34% of urban hospitals reported a ban). Bans were more common among hospitals serving patient populations with lower education levels (57% vs. 25%) and a higher proportion of patients on public insurance (57% vs. 34%). Only 8% of teaching hospitals had a ban (vs. 51% of nonteaching hospitals) and hospitals with CNMs on staff reported relatively fewer bans than those without (28% vs. 48%). CONCLUSION: Hospitals with VBAC bans are more likely to be smaller, rural, have a higher proportion of patients on public insurance, and lower average patient education levels. These findings suggest that VBAC policies may have differential impact on vulnerable populations reducing access to VBAC and increasing cesareans in that group.