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Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31829bd0a0
Original Research

Diminishing Availability of Trial of Labor After Cesarean Delivery in New Mexico Hospitals

Leeman, Lawrence M. MD, MPH; Beagle, Melissa MD, MPH; Espey, Eve MD, MPH; Ogburn, Tony MD; Skipper, Betty PhD

Cochrane Reviews
Clinical ObGyn
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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

© 2013 by The American College of Obstetricians and Gynecologists.

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