Diminishing availability of trial of labor after cesarean delivery in New Mexico hospitals.

Abstract:

OBJECTIVE:To examine the availability of trial of labor after cesarean delivery (TOLAC) in New Mexico from 1998 to 2012 and maternity care providers' perception of barriers to TOLAC. METHODS:Hospital maternity unit directors were surveyed regarding TOLAC availability from 1998 to 2012. Maternity care providers (obstetrician-gynecologists, certified nurse-midwives, and family medicine physicians) were surveyed in 2008 regarding resources and barriers to providing TOLAC and emergency cesarean delivery. RESULTS:Trial of labor after cesarean delivery was available in 100% of counties with maternity care units in 1998 (22/22); by 2008, availability decreased to 32% (7/22). After changes in national guidelines, availability increased slightly to 9 of 22 (41%) in 2012. Barriers to TOLAC included anesthesia availability (88%), hospital and medical malpractice policies (80%), malpractice cost (69%), and obstetric surgeon availability (59%). In hospitals without TOLAC services, 73% of maternity care providers indicated a surgeon could be present in the hospital within 20 minutes of the emergency delivery decision; only 43% indicated obstetric anesthesia personnel could be present within 20 minutes (P<.001). CONCLUSIONS:Availability of TOLAC in New Mexico has decreased dramatically. Policy changes are needed to support TOLAC access in rural and community hospitals. LEVEL OF EVIDENCE:III.

journal_name

Obstet Gynecol

authors

Leeman LM,Beagle M,Espey E,Ogburn T,Skipper B

doi

10.1097/AOG.0b013e31829bd0a0

subject

Has Abstract

pub_date

2013-08-01 00:00:00

pages

242-247

issue

2 Pt 1

eissn

0029-7844

issn

1873-233X

pii

00006250-201308000-00009

journal_volume

122

pub_type

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