Xu X, et al. – Given that trial of labor after cesarean (TOLAC) delivery has been acknowledged as a safe and affection option for women without contraindications, researchers assessed hospital variation in the utilization and success of TOLAC, and identified association institutional characteristics and patient outcomes. Using linked maternal and newborn hospital discharge records and birth certificate data in 2010-2012 from the state of California, they identified considerable variation in utilization and success rates of TOLAC across hospitals. An inverted U-shaped relationship was identified between risk-standardized utilization and success rates of TOLAC such that low or excessively high TOLAC use was associated with lower success rate. Utilization and success of TOLAC were noted in positive correlation with teaching status, system affiliation, larger volume, higher neonatal care capacity, anesthesia availability, higher proportion of midwife-attended births, and lower proportion of Medicaid or uninsured patients. However, there was a negative correlation of rural location and higher local malpractice insurance premium with TOLAC utilization, whereas lower success rate was evident in correlation with for-profit ownership.