If you are experiencing problems downloading PDF or HTML fulltext, our helpdesk recommend clearing your browser cache and trying again. If you need help in clearing your cache, please click here . Still need help? Email help@ingentaconnect.com

Changing Policies on Vaginal Birth after Cesarean: Impact on Access

$48.00 plus tax (Refund Policy)

Download / Buy Article:

Abstract:

ABSTRACT: 

Background: The issue of vaginal birth after cesarean (VBAC) has become highly visible and contentious. In 1999, the American College of Obstetricians and Gynecologists advocated a policy that surgical capability be “immediately available” for women in labor attempting VBAC. Methods: Every hospital in Colorado, Montana, Oregon, and Wisconsin was contacted by telephone at least once during the period 2003 to 2005. Using a semistructured interview, respondent hospitals were asked whether and when their policies for VBAC had changed and what was the availability of VBAC services before and after the 1999 policy was issued. Results: Of 314 hospitals contacted, 312 responded to the survey (response rate 99.4%). Babies were delivered at 230 (74%) respondent hospitals. Almost one-third, 68 of 222 (30.6%), of responding delivery hospitals that previously offered VBAC services had stopped doing so; seven hospitals had never allowed VBAC. Of the hospitals that still allowed VBAC, 68 percent had changed their VBAC policies since 1999, with the most frequent changes requiring the in-house presence of surgery (53%) and anesthesia (44%) personnel when women desiring VBAC presented in labor. Compared with hospitals that stopped allowing VBAC, those that currently permit VBAC were larger (156.6 vs 58.1 beds, t = 7.02, p < 0.001), closer to other delivery hospitals (20.9 vs 39.2 miles, t = 4.33, p < 0.001), annually delivered more babies (1009.9 vs 458.3, t = 4.41, p < 0.001), and annually had more cesarean deliveries (226.7 vs 105.7, t = 3.91, p < 0.001). Conclusions: In the years following advocacy of the 1999 policy, the availability of VBAC services significantly decreased, especially among smaller or more isolated hospitals. (BIRTH 34:4 December 2007)

Keywords: VBAC; access; policies; rural; vaginal birth after cesarean

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1523-536X.2007.00190.x

Affiliations: 1: Mark Deutchman is a Professor in the Department of Family Medicine, University of Colorado Health Sciences Center, Aurora, Colorado 2: Valerie King is an Associate Professor in the Department of Family Medicine, Oregon Health & Sciences University, Portland, Oregon 3: George Fryer is a Professor and Thomas Miyoshi is an Assistant Professor in the Department of Pediatrics, New York University School of Medicine, New York, New York, USA.

Publication date: December 1, 2007

Related content

Tools

Favourites

Share Content

Access Key

Free Content
Free content
New Content
New content
Open Access Content
Open access content
Subscribed Content
Subscribed content
Free Trial Content
Free trial content
Cookie Policy
X
Cookie Policy
ingentaconnect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more