A state-wide assessment of the obstetric, anesthesia, and operative team personnel who are available to manage the labors and deliveries and to treat the complications of women who attempt vaginal birth after cesarean delivery.
OBJECTIVE
The purpose of this study was to determine on a state-wide basis the range of obstetric, anesthesia, and surgical team personnel who were available immediately to manage the labors and deliveries of women who attempted vaginal birth after cesarean delivery. Additionally, we tried to determine whether hospitals had stopped performing vaginal births after cesarean delivery or made changes in their policies regarding vaginal birth after cesarean delivery as a result of recent American College of Obstetricians and Gynecologists recommendations.


METHODS
Available immediately was defined as "being present in the hospital." All hospitals that provided obstetric care in the State of Ohio were surveyed to determine whether an obstetrician with cesarean privileges, an anesthesiologist, or an anesthetist capable of independently administering anesthesia for a cesarean section, and a surgical team were available immediately when women attempted vaginal birth after cesarean delivery. The hospitals were also asked whether they had stopped allowing vaginal births after cesarean delivery or had made changes in their vaginal birth after cesarean delivery policies in response to the recent recommendations of the American College of Obstetricians and Gynecologists. Data were computerized and analyzed by the chi(2) test.


RESULTS
Seventy-seven (93.9%), 35 (100%), and 13 (100%) of level I, II, and III hospitals performed vaginal births after cesarean delivery. An obstetrician was immediately available in 27.3%, 62.9%, and 100% of level I, II, and III institutions, respectively (P <or=.001). Anesthesia availability was 39%, 100%, and 100% of level I, II, and III institutions, respectively (P <or=.001). A surgical team was available in 35.1%, 97.1%, and 100% of level I, II, and III hospitals, respectively (P <or=.001). A complete complement was available in 15.6%, 62.9%, and 100% of level I, II and III institutions, respectively (P <or=.001). Two hospitals had stopped the performance of vaginal births after cesarean delivery, and 10 additional hospitals were considering stopping the performance of vaginal births after cesarean delivery. Policy changes had been adopted in 15 institutions, and 4 other institutions were considering changes.


CONCLUSIONS
Most level I and many level II hospitals provide less than optimum staffing when women are attempting vaginal birth after cesarean delivery. Because vaginal births after cesarean delivery are equally distributed among level I, II, and III institutions in this state, many women may be attempting vaginal birth after cesarean delivery under less than optimal conditions. The data suggest the need for changes in staffing or referral patterns to safely meet the Healthy People 2010 goal of increasing the vaginal birth after cesarean delivery rate nationally.
Lavin
Justin P
JP
Division of Maternal Fetal Medicine, Summa Health System, Akron, Ohio, USA.
DiPasquale
Linda
L
Crane
Stephen
S
Stewart
John
J
D000773:Anesthesia, Obstetrical; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000628:therapy*; D009774:Obstetrics; D011247:Pregnancy; D000078329:Workforce