title: Vaginal birth after cesarean section in an HMO.
abstract: Despite a large body of evidence that vaginal birth after a previous cesarean section (VBAC) is safe, acceptance of the procedure in the community has been slow. This is in spite of the spiraling cesarean section rate and the strong endorsement of the American College of Obstetricians and Gynecologists (ACOG). Over a 30-month period, all patients presenting to a staff model HMO practice who met the ACOG criteria for VBAC were offered this option. Of 72 candidates, 66 attempted a trial of labor; only four required a repeat cesarean section. No complications were noted in any of the patients or infants. VBAC is a safe procedure, appropriate for a community-based practice, and can yield a high success rate. The implications for HMO obstetric policy are discussed.
mesh_terms: D017046:Cost Savings / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics*; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D007087:Illinois; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010358:Patient Participation; D011247:Pregnancy; D011256:Pregnancy Outcome; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*