Diminishing availability of trial of labor after cesarean delivery in New Mexico hospitals.

Abstract

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.