Linn George, Ying Yung-Hsiang, Chang Koyin
Show Chwan Memorial Hospital, Changhua, Taiwan.
Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan.
Ther Clin Risk Manag. 2019 Aug 13;15:991-1002. doi: 10.2147/TCRM.S205009. eCollection 2019.
Babies are sometimes delivered by cesarean section (CS) to women eligible for trial of labor after a cesarean (TOLAC) due to a fear of complications during the delivery process. This view is especially widespread in Taiwan, as evidenced by the extremely low rate (<5%) of vaginal birth after cesarean section (VBAC). To improve the safety and quality of childbirth and the obstetrical practice environment, this study aimed to identify ways to contain the ever-increasing rate of CS by investigating the determinants for TOLAC from the viewpoint of obstetricians.
A specially designed questionnaire was employed that incorporated the perceived risk of VBAC, institutional managerial attitude, and obstetricians' personal characteristics. Face-to-face surveys were conducted with obstetricians from across Taiwan. Regression analysis was used as appropriate.
Among the 231 recruited obstetricians, 86.7% were willing to undertake VBAC, but only 71.4% had actually done so. Obstetricians with a more risk-tolerant personality were more likely to undertake VBAC. Institutional characteristics, such as the time it takes to transfer a woman from the delivery table to the operating table (table to table) and the general facilities of the hospital to handle delivery complications resulting from VBAC were also key determinants for attempting VBAC.
In Taiwan, a country with a low birthrate, obstetricians need to be risk-tolerant to undertake VBAC. This phenomenon is probably due to underinvestment in facilities for vaginal delivery and thus a general perception that VBAC is risky. The study's results will potentially help medical institutions to adopt appropriate guidelines and build incentive structures to achieve a higher VBAC rate.
由于担心分娩过程中出现并发症，有时会对符合剖宫产术后阴道试产（TOLAC）条件的女性进行剖宫产（CS）。这种观点在台湾尤为普遍，剖宫产术后阴道分娩（VBAC）的极低发生率（<5%）就证明了这一点。为了提高分娩的安全性和质量以及产科执业环境，本研究旨在从产科医生的角度调查TOLAC的决定因素，以确定控制不断上升的剖宫产率的方法。
采用专门设计的问卷，其中纳入了对VBAC的感知风险、机构管理态度和产科医生的个人特征。对台湾各地的产科医生进行了面对面调查。酌情使用回归分析。
在招募的231名产科医生中，86.7%愿意进行VBAC，但实际进行过VBAC的只有71.4%。性格更能容忍风险的产科医生更有可能进行VBAC。机构特征，如将产妇从分娩台转移到手术台所需的时间（台对台）以及医院处理VBAC导致的分娩并发症的一般设施，也是尝试VBAC的关键决定因素。
在台湾这个低出生率的地区，产科医生需要有风险容忍度才能进行VBAC。这种现象可能是由于对阴道分娩设施投资不足，因此普遍认为VBAC有风险。该研究结果可能有助于医疗机构采用适当的指导方针并建立激励机制，以实现更高的VBAC率。
