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Saturday, July 27, 2013

Trailers (54): TOLAC in NM

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

Why should you read about this topic?

Because you want objective information on what is driving the trend toward extinction for TOLAC

What were the authors trying to do?

To describe the availability of TOLAC over time and to identify barriers to TOLAC services.

Who participated and in what setting?

Hospital maternity unit directors and maternity care providers in New Mexico surveyed by written and electronic mail between 1998-2012

What was the study design?

Cross-sectional

What were the main outcome measures?

TOLAC availability by county

What were the results?

Compared with 1998, TOLAC was available in 68% fewer New Mexico counties by 2008 and 59% fewer by 2012.  Survey respondents reported that anesthesia availability, hospital policy, and medical malpractice policies were the primary barriers to TOLAC access.

What is the most interesting image in the paper?

Figure

What were the study strengths and weaknesses?

Strengths:  excellent response rate for surveys.  Weaknesses: scant information on the conduct of the survey and the survey instrument; limited generalizability to the rest of the country; even if TOLAC is available, it is infrequently used.

What does the study contribute for your practice?

If TOLAC becomes extinct, expect to do more peripartum hysterectomies.