Roberts Richard G, Deutchman Mark, King Valerie J, Fryer George E, Miyoshi Thomas J
Department of Family Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin 53715, USA.
Birth. 2007 Dec;34(4):316-22. doi: 10.1111/j.1523-536X.2007.00190.x.
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.
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.
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).
In the years following advocacy of the 1999 policy, the availability of VBAC services significantly decreased, especially among smaller or more isolated hospitals.
剖宫产术后经阴道分娩（VBAC）问题已备受关注且颇具争议。1999年，美国妇产科医师学会倡导一项政策，即对于尝试VBAC的临产妇女，手术能力应“随时可用”。
在2003年至2005年期间，至少一次通过电话联系科罗拉多州、蒙大拿州、俄勒冈州和威斯康星州的每家医院。通过半结构化访谈，询问受访医院其VBAC政策是否以及何时发生了变化，以及在1999年政策发布之前和之后VBAC服务的可及性情况。
在联系的314家医院中，312家回复了调查（回复率99.4%）。230家（74%）受访医院进行了分娩。在之前提供VBAC服务的222家回复分娩医院中，近三分之一，即68家（30.6%）已停止提供此项服务；7家医院从未允许VBAC。在仍允许VBAC的医院中，自1999年以来，68%的医院改变了其VBAC政策，最常见的变化是当希望进行VBAC的妇女临产时，要求手术（53%）和麻醉（44%）人员在医院内随时待命。与停止允许VBAC的医院相比，目前允许VBAC的医院规模更大（156.6张床位对58.1张床位，t = 7.02，p < 0.001），距离其他分娩医院更近（20.9英里对39.2英里，t = 4.33，p < 0.001），每年分娩的婴儿更多（1009.9例对458.3例，t = 4.41，p < 0.001），每年进行的剖宫产更多（226.7例对105.7例，t = 3.91，p < 0.001）。
在倡导1999年政策后的几年里，VBAC服务的可及性显著下降，尤其是在规模较小或位置较偏远的医院。
