Changing policies on vaginal birth after cesarean: Impact on access
Changing policies on vaginal birth after cesarean: Impact on access
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DOI：
10.1111/j.1523-536x.2007.00190.x
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发表时间：
2007-12-01
影响因子：
2.5
通讯作者：
Miyoshi, Thomas J.
中科院分区：
文献类型：
--
作者：
Roberts, Richard G.;Deutchman, Mark;Miyoshi, Thomas J.
背景：剖宫产后阴道分娩(VBAC)的问题已经变得非常明显和有争议。1999年，美国妇产科医师学会倡导一项政策，即手术能力对尝试VBAC分娩的妇女“立即可用”。方法：2003年至2005年期间，科罗拉多州、蒙大拿州、俄勒冈州和威斯康星州的每家医院至少通过电话联系了一次。采用半结构化访谈的方法，询问受访医院对VBAC的政策是否以及何时发生了变化，以及1999年政策发布前后VBAC服务的可获得性如何。结果：在调查的314家医院中，有312家医院进行了问卷调查，应答率为99.4%。婴儿是在230家(74%)受访医院分娩的。在之前提供VBAC服务的响应医院中，几乎三分之一，即222家医院中的68家(30.6%)已经停止提供VBAC服务；7家医院从未允许VBAC服务。在仍然允许VBAC的医院中，68%的医院自1999年以来改变了VBAC政策，其中最频繁的变化需要手术(53%)和麻醉人员(44%)在要求VBAC的妇女分娩时在内部在场。与不再允许VBAC的医院相比，目前允许VBAC的医院更大(156.6张床位比58.1张床位，t=7.02，p<；0.001)，离其他分娩医院更近(20.9vs39.2英里，t=4.33，p<；0.001)，每年接生更多的婴儿(1009.9比458.3，t=4.41，p<；0.001)，每年剖腹产(226.7比105.7，t=3.91，p<；0.001)。结论：在1999年政策倡导后的几年里，VBAC服务的可用性显著下降，特别是在较小或更孤立的医院中。
Background: The issue of vaginal birth after cesarean (VBAC) has become highly visible and contentious. In 1999, the American College of Obstetricians and Gynecologists advocated a policy that surgical capability be "immediately available" for women in labor attempting VBAC. Methods: Every hospital in Colorado, Montana, Oregon, and Wisconsin was contacted by telephone at least once during the period 2003 to 2005. Using a semistructured interview, respondent hospitals were asked whether and when their policies for VBAC had changed and what was the availability of VBAC services before and after the 1999 policy was issued. Results: Of 314 hospitals contacted, 312 responded to the survey (response rate 99.4%). Babies were delivered at 230 (74%) respondent hospitals. Almost one-third, 68 of 222 (30.6%), of responding delivery hospitals that previously offered VBAC services had stopped doing so; seven hospitals had never allowed VBAC. Of the hospitals that still allowed VBAC, 68 percent had changed their VBAC policies since 1999, with the most frequent changes requiring the in-house presence of surgery (53%) and anesthesia (44%) personnel when women desiring VBAC presented in labor. Compared with hospitals that stopped allowing VBAC, those that currently permit VBAC were larger (156.6 vs 58.1 beds, t = 7.02, p < 0.001), closer to other delivery hospitals (20.9 vs 39.2 miles, t = 4.33, p < 0.001), annually delivered more babies (1009.9 vs 458.3, t = 4.41, p < 0.001), and annually had more cesarean deliveries (226.7 vs 105.7, t = 3.91, p < 0.001). Conclusions: In the years following advocacy of the 1999 policy, the availability of VBAC services significantly decreased, especially among smaller or more isolated hospitals.