Teaching Vaginal Breech Delivery And External Cephalic Version - A Survey Of Faculty Attitudes
breech presentation; cesarean; cesarean-section; experience; external cephalic version; fetal; medical; mode; mortality; Obstetrics & Gynecology; outcomes; pregnancy; residency; section; term; trial; vaginal breech delivery; version
OBJECTIVE: To ascertain current faculty attitudes regarding teaching of vaginal breech delivery (VBD) and external cephalic version (ECV). STUDY DESIGN: A questionnaire was sent to obstetrics ann gynecology residency programs. Respondents were queried regarding demographic parameters, resident and practice experience, and attitudes toward teaching these procedures. RESULTS: Fifty-four (96%:) surveys were returned. Sixteen (30%) respondents were female and 38 (70%) male. Sixteen (30%) completed residency prior to 1980, 17 (32%) during the 1980s and 21 (48%) during the 1990s. Nineteen (35%) trained locally. Forty-seven (87%) recieved training in ECV. Thirty-two rcsirlency. Thirty-five (65%) recieved training in ECV. Thirty-two (60%) had performed VBDs in practice. However, only 18 (33%) continued to perform this procedure. During the proceeding three years, they reported performing an average average of five VBDs per chief resident per year. Thirty-seven (69%) performed ECV ill clinical practice. The 17 who did not indicated that they refered to others. They reported performing an average of 15 ECVs per chief resident per year. Fifty-two (96%) thought residents should still be taught VBD. All faculty throught that residents should be taught ECV. None of the above parameters exerted a statistically significant effect on these opinions. CONCLUSION: There tons nearly universal faculty support for continuing to teach VBD to residents. However, only one-third of faculty members currently perform this procedure. There do not appear to be sufficient numbers of VBDs to teach this procedure utilizing a "hands on" approach. There is universal support for teaching ECV. There appear to be both enough individuals with experience and enough procedures to accomplish this education.
Lavin J P; Eaton J; Hopkins M
Journal of Reproductive Medicine
2000
2000-10
Journal Article or Conference Abstract Publication
n/a
A State-wide Assessment Of The Obstetric, Anesthesia, And Operative Team Personnel Who Are Available To Manage The Labors And Deliveries And To Treat The Complications Of Women Who Attempt Vaginal Birth After Cesarean Delivery
experience; obstetric personnel; Obstetrics & Gynecology; section; trial; uterine rupture; vaginal birth after cesarean delivery
OBJECTIVE: The purpose of this study was to determine on a state-wide basis the range of obstetric, anesthesia, and surgical team personnel who were available immediately to manage the labors and deliveries of women who attempted vaginal birth after cesarean delivery. Additionally, we tried to determine whether hospitals had stopped performing vaginal births after cesarean delivery or made changes in their policies regarding vaginal birth after cesarean delivery as a result of recent American College of Obstetricians and Gynecologists recommendations. STUDY DESIGN: Available immediately was defined as "being present in the hospital." All hospitals that provided obstetric care in the State of Ohio were surveyed to determine whether an obstetrician with cesarean privileges, an anesthesiologist, or an anesthetist capable of independently administering anesthesia for a cesarean section, and a surgical team were available immediately when women attempted vaginal birth after cesarean delivery. The hospitals were also asked whether they had stopped allowing vaginal births after cesarean delivery or had made changes in their vaginal birth after cesarean delivery policies in response to the recent recommendations of the American College of Obstetricians and Gynecologists. Data were computerized and analyzed by the chi(2) test. RESULTS: Seventy-seven (93.9%), 35 (100%), and 13 (100%) of level I, II, and III hospitals performed vaginal births after cesarean delivery. An obstetrician was immediately available in 27.3%, 62.9%, and 100% of level I, II, and III institutions, respectively (P less than or equal to .001). Anesthesia availability was 39%, 100%, and 100% of level I, II, and III institutions, respectively (P less than or equal to .001). A surgical team was available in 35.1%, 97.1%, and 100% of level I, II, and III hospitals, respectively (P less than or equal to .001). A complete complement was available in 15.6%, 62.9%, and 100% of level I, II and III institutions, respectively (P less than or equal to .001). Two hospitals had stopped the performance of vaginal births after cesarean delivery, and 10 additional hospitals were considering stopping the performance of vaginal births after cesarean delivery. Policy changes had been adopted in 15 institutions, and 4 other institutions were considering changes. CONCLUSION: Most level I and many level II hospitals provide less than optimum staffing when women are attempting vaginal birth after cesarean delivery. Because vaginal births after cesarean delivery are equally distributed among level I, II, and I I I institutions in this state, many women may be attempting vaginal birth after cesarean delivery under less than optimal conditions. The data suggest the need for changes in staffing or referral patterns to safely meet the Healthy People 2010 goal of increasing the vaginal birth after cesarean delivery rate nationally.
Lavin J P; DiPasquale L; Crane S; Stewart J
American Journal of Obstetrics and Gynecology
2002
2002-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1067/mob.2002.124282" target="_blank" rel="noreferrer noopener">10.1067/mob.2002.124282</a>