Changing policies on vaginal birth after cesarean: Impact on access

Richard G. Roberts, Mark Deutchman, Valerie King, George E. Fryer, Thomas J. Miyoshi

Research output: Contribution to journalArticle

40 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)316-322
Number of pages7
JournalBirth
Volume34
Issue number4
DOIs
StatePublished - Dec 2007

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Keywords

  • Access
  • Policies
  • Rural
  • Vaginal birth after cesarean
  • VBAC

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Nursing(all)

Cite this

Roberts, R. G., Deutchman, M., King, V., Fryer, G. E., & Miyoshi, T. J. (2007). Changing policies on vaginal birth after cesarean: Impact on access. Birth, 34(4), 316-322. https://doi.org/10.1111/j.1523-536X.2007.00190.x

Changing policies on vaginal birth after cesarean : Impact on access. / Roberts, Richard G.; Deutchman, Mark; King, Valerie; Fryer, George E.; Miyoshi, Thomas J.

In: Birth, Vol. 34, No. 4, 12.2007, p. 316-322.

Research output: Contribution to journalArticle

Roberts, RG, Deutchman, M, King, V, Fryer, GE & Miyoshi, TJ 2007, 'Changing policies on vaginal birth after cesarean: Impact on access', Birth, vol. 34, no. 4, pp. 316-322. https://doi.org/10.1111/j.1523-536X.2007.00190.x
Roberts, Richard G. ; Deutchman, Mark ; King, Valerie ; Fryer, George E. ; Miyoshi, Thomas J. / Changing policies on vaginal birth after cesarean : Impact on access. In: Birth. 2007 ; Vol. 34, No. 4. pp. 316-322.
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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.",
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