Optional vaginal delivery rate. An informative indicator of intrapartum care.
OBJECTIVE
To determine whether an "optional" vaginal delivery rate and novel delivery score would provide informative profiles of intrapartum care.


METHODS
Prospective survey of all parturients delivering between January and December 1996. Deliveries were categorized as standard-vaginal (V-S), optional-vaginal (V-O), standard-cesarean (C-S) or potentially avoidable-cesarean (C-PA) using specific perinatal criteria derived from the literature. A weighted equation was developed and applied, generating physician delivery scores, giving "extra credit" for V-O and a "debit" for C-PA: delivery score = [(% V-O x 2) + (% V-S) - (% C-PA] x 100.


RESULTS
V-O rates and delivery scores ranged from 0% to 25% and from 52 to 113, respectively (medians of 9.8% and 92.9). Among the obstetricians (n = 38), a significant inverse correlation was noted between the total C-S rates and V-O rates (r = -.54, P < .005). The maternal-fetal medicine physicians (n = 6) had high total C-S rates (22-36%) but also had high V-O rates (17.1-23.5%) and high delivery scores (82.1-101.5).


CONCLUSIONS
The optional vaginal delivery rate and delivery score are more-informative indicators of intrapartum management acumen than is cesarean section rate alone. We suggest incorporating these descriptors into departmental quality assurance programs.
Haney
E I
EI
Department of Obstetrics and Gynecology, Northwestern University Medical School, Evanston Northwestern Healthcare, Illinois, USA.
Reiter
J A
JA
MacGregor
S N
SN
Silver
R K
RK
D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D008427:Maternal Health Services; D008962:Models, Theoretical; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011446:Prospective Studies; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*