Would the Use of a Vaginal Birth After Cesarean Calculator Better Improve our Counseling and Allow us to Better Predict Success Rates for Trial of Labor After Cesarean? [324]. (May 2015)

• Record Type: Journal Article
• Authors: Falcone-Wharton, Amy; Tucker-Edmonds, Brownsyne
• Is Part Of: Obstetrics and gynecology. Volume 125(2015)Supplement 1
• Publication Date: 2015-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000463633.98296.cc
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : OBJECTIVE: To compare how providers predict the success rates for patients qualifying for vaginal birth after cesarean (VBAC) given a set of patient characteristics versus a calculation and to evaluate their estimation for successful VBAC. STUDY DESIGN: We surveyed obstetric providers at an ACOG Section Meeting. The observational survey included demographic questions and clinical vignettes. Providers were asked to report how they would counsel each patient regarding VBAC by estimating the patient's chance of a success. The likelihood of successful VBAC was calculated for each vignette using the online Maternal-Fetal Medicine Units VBAC calculator. Providers were then asked to report how they would counsel each patient based solely on a specific rate of success. This pilot study examined differences in counseling based certain patient characteristics compared to the calculation and examined how consistent providers were at predicting the chance of success for VBAC. RESULTS: One hundred one surveys were distributed and 79 returned. Agreement between five vignettes and matching items with calculated chance of success were increasingly consistent as the chance for successful VBAC per the calculator was higher. Providers overestimated the chance for successful VBAC significantly in all vignettes at an average of 66%, except for the vignette that had the highest chance for success of 96.6%, in which they under predicted success rate by 33%. Clinicians consistently felt that the factors that most influence successful VBAC are age, race and prior successful VBAC. CONCLUSION: We have demonstrated that providers are fairly inconsistent in their counseling on trial of labor after cesarean (TOLAC). We recommend that providers utilize the VBAC calculator for a trial period to see if they are consistent in their counseling for TOLAC. If they are overestimating the change for successful VBAC in their counseling, this realization could influence their counseling and perhaps help reduce morbidity associated with failed TOLAC.