Departments of Obstetrics and Gynecology and Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico; and Denver Health Medical Center, Denver, Colorado.
Obstet Gynecol. 2013 Aug;122(2 Pt 1):242-247. doi: 10.1097/AOG.0b013e31829bd0a0.
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.
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.
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).
Availability of TOLAC in New Mexico has decreased dramatically. Policy changes are needed to support TOLAC access in rural and community hospitals.
III.
考察 1998 年至 2012 年新墨西哥州剖宫产术后试产（TOLAC）的可用性以及母婴保健提供者对 TOLAC 障碍的看法。
对 1998 年至 2012 年医院产科单位主任进行 TOLAC 可用性调查。2008 年对产科医生-妇科医生、认证护士助产士和家庭医生进行母婴保健提供者资源和提供 TOLAC 和紧急剖宫产障碍的调查。
1998 年（22/22）有产科单位的县 100%提供 TOLAC；到 2008 年，可用性降至 32%（7/22）。在国家指南发生变化后，2012 年可用性略有增加至 22 个中的 9 个（41%）。TOLAC 的障碍包括麻醉剂可用性（88%）、医院和医疗事故政策（80%）、事故成本（69%）和产科外科医生可用性（59%）。在没有 TOLAC 服务的医院中，73%的母婴保健提供者表示外科医生可以在紧急分娩决定后 20 分钟内到达医院；只有 43%的人表示产科麻醉人员可以在 20 分钟内到达（P<.001）。
新墨西哥州 TOLAC 的可用性大幅下降。需要政策变更来支持农村和社区医院的 TOLAC 准入。
III。
