Impact of Anesthesiologists on the Incidence of Vaginal Birth After Cesarean in the United States: Role of Anesthesia Availability, Productivity, Guidelines, and Patient Safety

David J. Birnbach, Brenda A. Bucklin, Franklin Dexter

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations

Abstract

The rate of vaginal birth after cesarean delivery (VBAC) has been steadily decreasing in the United States. What is not clear, however, is what part the availability of anesthesia personnel has played in this reduction. We review the role of anesthesia services in the trend of the decreasing rates of VBAC. Three areas of particular interest to anesthesiology services are addressed: (1) the current ability of anesthesiologists in the United States to provide "immediate" availability for VBAC at all delivery locations; (2) the workforce estimates for anesthesiology staffing in the future; and (3) the barriers to the immediate availability of anesthesiologists in all hospitals that provide obstetrical care. The concept of "immediate availability" is discussed, and examples of ways to reduce the risks to patients are provided. Finally, possible solutions that may improve patient safety without a dramatic increase in number of anesthesiologists available to work on labor and delivery units are highlighted.

Original languageEnglish (US)
Pages (from-to)318-324
Number of pages7
JournalSeminars in Perinatology
Volume34
Issue number5
DOIs
StatePublished - Oct 2010

Keywords

  • Anesthesiology
  • Availability
  • Immediate availability
  • Obstetric anesthesia
  • Patient safety
  • Risk classification
  • Workforce

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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