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Providers' perspectives on the vaginal birth after cesarean guidelines in Florida, United States: a qualitative study

DOI: 10.1186/1471-2393-11-72

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Semi-structured interviews were conducted with 11 obstetricians, 12 midwives, and a hospital administrator (n = 24). Interviews were recorded and transcribed verbatim, and thematic analysis informed the findings.Fear of liability was a central reason for obstetricians and midwives to avoid attending VBACs. Providers who continued to offer a trial of labor attempted to minimize their legal risks by being highly selective in choosing potential candidates. Definitions of "immediately available" varied widely among hospitals, and providers in solo or small practices often favored the convenience of a repeat cesarean delivery rather than having to remain in-house during a trial of labor. Midwives were often marginalized due to restrictive hospital policies and by their consulting physicians, even though women with previous cesareans were actively seeking their care.The current ACOG VBAC guidelines limit US obstetricians' and midwives' ability to provide care for women with a previous cesarean, particularly in community and rural hospitals. Although ACOG has proposed that women be allowed to accept "higher levels of risk" in order to be able to attempt a trial of labor in some settings, access to VBAC is unlikely to increase in Florida as long as systemic barriers and liability risks remain high.In the United States and other developed countries, the vaginal birth after cesarean (VBAC) rate has been steadily declining for more than a decade [1,2]. Only 8.2% of US women with a previous cesarean delivery attempted a vaginal birth in 2007, compared with 35.3% in 1997, despite evidence that 60% to 80% of VBACs are successful [1]. A similar trend is apparent in Australia, where VBAC rates declined from 31% in 1998 to 19% in 2006 [2]. Although VBAC has been extensively validated as a safe option for most women with a previous cesarean [1], non-medical factors are thought to be driving the decline in rates since medical factors have changed little over the years [3].Prior to the


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