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The UTAH VBAC Study.

Greg Gochnour1, Stephen Ratcliffe, Mary Bishop Stone

  • 1McKay Dee Family Medicine Residency Program, Ogden, Utah.

Maternal and Child Health Journal
|June 21, 2005
PubMed
Summary
This summary is machine-generated.

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Physician awareness of ACOG guidelines on vaginal birth after cesarean (VBAC) is high, but VBAC rates have declined since 1999. Rural physicians face challenges complying with immediate C-section availability for trial of labor (TOL).

Area of Science:

  • Obstetrics and Gynecology
  • Healthcare Policy
  • Maternal Health

Background:

  • The American College of Obstetricians and Gynecologists (ACOG) issued Practice Guideline number 5 in 1999 regarding vaginal birth after cesarean section (VBAC) and trial of labor (TOL).
  • This guideline recommends immediate physician availability during TOL for rare complications.
  • The study investigates the impact of this guideline on VBAC/TOL practices in Utah.

Purpose of the Study:

  • To assess physician awareness of ACOG Practice Guideline number 5.
  • To evaluate changes in VBAC practices over the preceding 12 months.
  • To determine physician compliance with ACOG guideline recommendations based on location (rural, suburban, urban).

Main Methods:

  • A mail survey was conducted in spring 2001 targeting all obstetrics physicians in Utah.

Related Experiment Videos

  • The survey collected data on physician demographics, hospital characteristics, VBAC/TOL practices, and awareness of ACOG Guideline number 5.
  • Physicians were categorized as urban, suburban, or rural based on their primary delivery hospital's location.

    • Main Results:

    • Awareness of ACOG Practice Guideline number 5 was high: 97% for obstetricians and 79% for family physicians.
    • Forty-five percent of physicians reported a decrease in VBAC practices in the prior year.
    • Physician compliance with immediate C-section availability varied by location, with rural physicians showing the lowest compliance (76%).

    Conclusions:

    • Physician practices regarding VBAC/TOL have shifted since the 1999 ACOG guideline update, with fewer TOLs and more repeat cesarean sections.
    • This decline in VBAC/TOL is more pronounced in suburban and rural hospitals, aligning with national trends.
    • Many rural physicians encounter difficulties in adhering to the ACOG guideline's requirement for immediate C-section availability during TOL.