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Updated: Jun 8, 2026

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
11:27

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Published on: April 7, 2023

The immediately available physician standard.

Howard Minkoff1, Dmitry Fridman

  • 1Department of Obstetrics and Gynecology at Maimonides Medical Center, Brooklyn, NY 11219, USA. hminkoff@maimonidesmed.org

Seminars in Perinatology
|September 28, 2010
PubMed
Summary
This summary is machine-generated.

The immediately available physician standard has decreased vaginal birth after cesarean (VBAC) rates. Hospitals should aim for an available team for all laboring patients, tailoring informed consent to individual risks and site characteristics.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Healthcare Management

Background:

  • The implementation of the immediately available physician standard has led to a significant decrease in vaginal birth after cesarean (VBAC) rates.
  • While an immediately available obstetrician during a VBAC trial reduces risk, its necessity for all laboring patients, including those without uterine scars, is debated.

Purpose of the Study:

  • To analyze the impact of the immediately available physician standard on VBAC rates.
  • To propose strategies for maintaining VBAC accessibility while ensuring patient safety.

Main Methods:

  • Review of current obstetric standards and their effect on VBAC rates.
  • Analysis of risk factors associated with VBAC and birthing site characteristics.
  • Development of recommendations for hospital staffing and informed consent protocols.

Main Results:

  • The 'immediately available physician' standard has contributed to a decline in VBACs.
  • Many hospitals face challenges in staffing to meet this standard.
  • Alternative approaches may support VBAC for carefully selected patients.

Conclusions:

  • Hospitals should strive to provide an immediately available team for all laboring patients.
  • Informed consent processes must be individualized, considering patient risk profiles and site-specific resources.
  • Smaller hospitals unable to routinely provide an immediately available team should explore options like on-call teams for VBAC trials and allowing labor for lower-risk patients.