142nd APHA Annual Meeting and Exposition

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Impact of new ACOG guidelines on VBAC availability: Perspectives from national surveys before and after the guidelines

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Allison Potter, MPH Student , Maternal and Child Health, Boston University School of Public Health, Boston, MA
Kylia Garver, MPH Student , Maternal and Child Health, Boston University School of Public Health, Boston, MA
Christina Gebel, MPH student , Maternal and Child Health, Boston University School of Public Health, Boston, MA
Eugene Declercq, PhD , Community Health Sciences Department, Boston University School of Public Health, Boston, MA
Background: New guidelines issued by the American Congress of Obstetricians and Gynecologists (ACOG) were intended to increase availability of vaginal births after cesareans (VBAC). This presentation will examine maternal experience with VBACs before and after the guidelines.

Methods: Listening to Mothers II (2005; n=1573) and III (2011/12; n=2416) are nationally representative surveys of mothers. Mothers described their options and experiences with VBAC decision making in response to closed and open-ended questions with results analyzed nationally and by region.

Results: Before and after the new guidelines, there was no significant change in mothers’ interest in a VBAC (45% to 48%) (p=.62); option to have a VBAC (52% to 56%) (p=.52) or the actual VBAC rate among respondents (11% to 14%) (p=.24). The option for a VBAC varied by region: West (65%), Northeast (60%), Midwest (38%) and South (27%) (p<.01).  There was a significant (p<.001) increase in the proportion of mothers denied a VBAC for a medical reason (20% to 45%) (p<.001). Mothers who discussed the option of a VBAC with their provider less likely to have a VBAC (7%) than those who did not report engaging in such a discussion (17%) (p<.01).

Conclusion: Analysis of data from national surveys before and after the issuance of new guidelines on VBACs finds no change in availability of VBACs, but an increase in reporting of medical reasons for denial of VBAC and a decreased likelihood of a VBAC when mothers engage in shared decision making with their provider.

Learning Areas:

Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related research

Learning Objectives:
Compare differences and similarities in maternal perspectives on VBACs before and after the release of VBAC clinical guidelines by ACOG. Describe mothers' experiences with shared decision making concerning VBACs. Summarize regional differences in VBAC availability.

Keyword(s): Maternal and Child Health, Birth Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was part of the team that developed and implemented the surveys that are at the core of this analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 2040.0: Poster Session: Innovations in Maternity Care