title: Vaginal birth after cesarean: do California hospital policies follow national guidelines?
abstract: OBJECTIVE
  To review whether California hospitals are adhering to national practice guidelines with regard to vaginal birth after cesarean (VBAC).
  
  
  METHODS
  We performed a content analysis of the American College of Obstetricians and Gynecologists (ACOG) and American Association of Family Physicians published guidelines and identified 39 specific recommendations, which were categorized into the following 5 content areas: patient criteria, procedure, staff and resources, uterine rupture or other complications, and miscellaneous clinical issues. We evaluated individual hospital policies with regard to adherence to 34 recommendations made specifically by ACOG.
  
  
  RESULTS
  Of the 225 surveyed hospitals, 167 (74%) allow VBAC, and 22% of these (36 of 167) provided VBAC protocols for review. Approximately 80% of protocols included < 50% of the ACOG items (median, 13.5; range, 3-27 items). The highest percent adherence was observed in the procedure and staff and resources categories, where over two thirds of study hospitals exhibited 75-100% adherence. One third of participating hospitals were less adherent (0-25%) in the categories of patient criteria, uterine rupture or other complications, and miscellaneous clinical issues.
  
  
  CONCLUSIONS
  In a sample of written VBAC protocols, we found a wide range of adherence to ACOG recommendations, as evidenced by the number and type of items explicitly documented in the protocols.
authors.affiliation: Department of Obstetrics and Gynecology, Nursing Research Institute, Cedars-Sinai Medical Center, 8635 West 3rd Street, Los Angeles, CA 90048, USA.
authors.forename: Ida R
authors.initials: IR
authors.lastname: Shihady
authors.forename: Paula
authors.initials: P
authors.lastname: Broussard
authors.forename: Linda Burnes
authors.initials: LB
authors.lastname: Bolton
authors.forename: Arlene
authors.initials: A
authors.lastname: Fink
authors.forename: Moshe
authors.initials: M
authors.lastname: Fridman
authors.forename: Rachel
authors.initials: R
authors.lastname: Fridman
authors.forename: Carolyn
authors.initials: C
authors.lastname: Aydin
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Korst
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Gregory
mesh_terms: D002140:California; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D016064:Vaginal Birth after Cesarean