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Author: U. S. Department Human Services
Publisher: CreateSpace
ISBN: 9781499519822
Category :
Languages : en
Pages : 70
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Book Description
The rate of cesarean delivery in the United States increased dramatically over the past two decades, from 20.7 percent in 1996 to 32.8 percent in 2010. Part of the reason for the increase is a decline in the rate of vaginal birth after cesarean (VBAC). Although the dictum "once a cesarean, always a cesarean" guided clinical practice for a good part of the 20th century, a 1980 National Institutes of Health (NIH) Consensus Development Conference Panel recognized trial of labor (TOL) after prior cesarean as a viable option for certain low-risk women.3 An increase in VBAC ensued; by 1996, more than 28 percent of women with a prior cesarean delivered vaginally. However, a number of medical and nonmedical factors, including reports in the 1990s of an increased risk of maternal complications with TOL compared with elective repeat cesarean, pushed the pendulum in the opposite direction. The percentage of women with a previous cesarean delivering vaginally fell from a peak of 28 percent in 1996 to 8.5 percent in 2007. In 2010, NIH again convened a Consensus Development Conference Panel to evaluate the growing body of evidence on the clinical risks and benefits of TOL after cesarean. In preparation for the 2010 conference, the Agency for Healthcare Research and Quality (AHRQ) commissioned the Oregon Evidence-based Practice Center (EPC) to conduct a review of the evidence on a number of emerging issues related to VBAC, which was released as AHRQ Evidence Report/Technology Assessment No. 191. The evidence review addressed the following six Key Questions. 1. What are the rates and patterns of utilization of trial of labor after prior cesarean, vaginal birth after cesarean, and repeat cesarean delivery in the United States? 2. What are the nonmedical factors (e.g., provider type, hospital type) that influence the patterns and utilization of trial of labor after prior cesarean? 3. Among women who attempt a trial of labor after prior cesarean, what are the vaginal delivery rate and the factors that influence it? 4. What are the short- and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean compared with elective repeat cesarean delivery, and what factors influence benefits and harms? 5. What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean compared with elective repeat cesarean delivery, and what factors influence benefits and harms? 6. What are the critical gaps in the evidence for decisionmaking, and what are priority investigations needed to address these gaps?
Author: U. S. Department Human Services
Publisher: CreateSpace
ISBN: 9781499519822
Category :
Languages : en
Pages : 70
Get Book
Book Description
The rate of cesarean delivery in the United States increased dramatically over the past two decades, from 20.7 percent in 1996 to 32.8 percent in 2010. Part of the reason for the increase is a decline in the rate of vaginal birth after cesarean (VBAC). Although the dictum "once a cesarean, always a cesarean" guided clinical practice for a good part of the 20th century, a 1980 National Institutes of Health (NIH) Consensus Development Conference Panel recognized trial of labor (TOL) after prior cesarean as a viable option for certain low-risk women.3 An increase in VBAC ensued; by 1996, more than 28 percent of women with a prior cesarean delivered vaginally. However, a number of medical and nonmedical factors, including reports in the 1990s of an increased risk of maternal complications with TOL compared with elective repeat cesarean, pushed the pendulum in the opposite direction. The percentage of women with a previous cesarean delivering vaginally fell from a peak of 28 percent in 1996 to 8.5 percent in 2007. In 2010, NIH again convened a Consensus Development Conference Panel to evaluate the growing body of evidence on the clinical risks and benefits of TOL after cesarean. In preparation for the 2010 conference, the Agency for Healthcare Research and Quality (AHRQ) commissioned the Oregon Evidence-based Practice Center (EPC) to conduct a review of the evidence on a number of emerging issues related to VBAC, which was released as AHRQ Evidence Report/Technology Assessment No. 191. The evidence review addressed the following six Key Questions. 1. What are the rates and patterns of utilization of trial of labor after prior cesarean, vaginal birth after cesarean, and repeat cesarean delivery in the United States? 2. What are the nonmedical factors (e.g., provider type, hospital type) that influence the patterns and utilization of trial of labor after prior cesarean? 3. Among women who attempt a trial of labor after prior cesarean, what are the vaginal delivery rate and the factors that influence it? 4. What are the short- and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean compared with elective repeat cesarean delivery, and what factors influence benefits and harms? 5. What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean compared with elective repeat cesarean delivery, and what factors influence benefits and harms? 6. What are the critical gaps in the evidence for decisionmaking, and what are priority investigations needed to address these gaps?
Author: Department of Human Services
Publisher: CreateSpace
ISBN: 9781499520194
Category :
Languages : en
Pages : 48
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Book Description
Vaginal birth after cesarean (VBAC) describes vaginal delivery by a woman who has had a previous cesarean delivery. For most of the 20th century, once a woman had undergone a cesarean delivery, clinicians believed that her future pregnancies required cesarean delivery. Studies from the 1960s suggested that this practice may not always be necessary. In 1980, a National Institutes of Health (NIH) Consensus Development Conference Panel questioned the necessity of routine repeat cesarean deliveries and outlined situations in which VBAC could be considered. The option for a woman with a previous cesarean delivery to have a trial of labor was offered and exercised more often in the 1980s through 1996. Since 1996, however, the number of VBACs has declined, contributing to the overall increase in cesarean delivery (Figure 1). Although we recognize that primary cesarean deliveries are the driving force behind the total cesarean delivery rates, the focus of this report is on trial of labor and repeat cesarean deliveries. A number of medical and nonmedical factors have contributed to this decline in the VBAC rate since the mid-1990s, although many of these factors are not well understood. A significant medical factor that is frequently cited as a reason to avoid trial of labor is concern about the possibility of uterine rupture-because an unsuccessful trial of labor, in which a woman undergoes a repeat cesarean delivery instead of a vaginal delivery, has a a higher rate of complications compared to VBAC or elective repeat cesarean delivery. Nonmedical factors include, among other things, restrictions on access to a trial of labor and the effect of the current medical-legal climate on relevant practice patterns. To advance understanding of these important issues, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of Medical Applications of Research of NIH convened a Consensus Development Conference on March 8-10, 2010. The conference was grounded in the view that a thorough evaluation of the relevant research would help pregnant women and their maternity care providers when making decisions about the mode of delivery after a previous cesarean delivery. Improved understanding of the clinical risks and benefits and how they interact with nonmedical factors also may have important implications for informed decisionmaking and health services planning. The following key questions were addressed by the Consensus Development Conference: 1. What are the rates and patterns of utilization of trial of labor after prior cesarean delivery, vaginal birth after cesarean delivery, and repeat cesarean delivery in the United States? 2. Among women who attempt a trial of labor after prior cesarean delivery, what is the vaginal delivery rate and the factors that influence it? 3. What are the short-and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms? 4. What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms? 5. What are the nonmedical factors that influence the patterns and utilization of trial of labor after prior cesarean delivery? 6. What are the critical gaps in the evidence for decisionmaking, and what are the priority investigations needed to address these gaps?
Author: U. S. Department of Health and Human Services
Publisher: CreateSpace
ISBN: 9781484162323
Category : Medical
Languages : en
Pages : 414
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Book Description
Despite the Healthy People 2010 national goal to reduce the cesarean delivery rate to 15 percent of births each year, this century has set record rates of cesarean deliveries. When the national rate of cesarean delivery was first measured in 1965, it was 4.5 percent, in 2007, almost one in three women in the United States (U.S.) delivered by cesarean (32.8 percent cesarean delivery rate in 2007). With almost 1.5 million cesarean surgeries performed every year, cesarean is the most common surgical procedure in the U.S. Vaginal birth after cesarean (VBAC) emerged from the 1980 National Institutes of Health (NIH) Consensus Conference on Cesarean as a mechanism to safely reduce the cesarean delivery rate. VBAC proved to be an effective contributor to reduce the use of cesarean through the early 1990s. From 1990 through 1996, the VBAC rate rose from 19.9 to 28.3 percent and the cesarean rate declined from 22.7 to 20.7 percent. Since 1996, VBAC rates have declined sharply, to the point where over 90 percent of women with a prior cesarean will deliver by repeat cesarean. While primary cesarean accounts for the largest number of cesarean deliveries, the largest single indication for cesarean is prior cesarean accounting for 534,180 cesareans each year, thus the safety of VBAC remains important. The degree to which cesarean deliveries and VBACs are improving or adversely affecting health remains a subject of continued controversy and uncertainty. This systematic review was conducted to inform the 2010 NIH Consensus Development Conference to evaluate emerging issues relating to VBAC. An evidence report focuses attention on the strengths and limits of evidence from published studies about the effectiveness and/or harms of a clinical intervention. The development of an evidence report begins with a careful formulation of the problem. The Evidence-based Practice Center (EPC) systematically reviewed the relevant scientific literature on key questions relating to VBAC assigned by the Agency for Healthcare Research and Quality (AHRQ), the Planning Committee for the NIH Consensus Development Conference on VBAC: New Insights, the National Institutes of Health's Office of Medical Applications of Research (OMAR), and further refined by a technical expert panel (TEP). Ultimately, two background questions and four key questions were reviewed for this report: What are the rates and patterns of utilization of trial of labor after prior cesarean, vaginal birth after cesarean, and repeat cesarean deliveries in the United States? What are the nonmedical factors (provider type, hospital type, etc.) that influence the patterns and utilization of trial of labor after prior cesarean? Background questions will be addressed in the introduction of the report with information from reputable sources; however, these data are not part of the systematic review process. Key Questions include: 1. Among women who attempt a trial of labor after prior cesarean, what is the vaginal delivery rate and the factors that influence it? 2. What are the short- and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms? 3.What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms? 4. What are the critical gaps in the evidence for decision-making, and what are the priority investigations needed to address these gaps?
Author: Elizabeth Mitchell Armstrong
Publisher: Emerald Group Publishing
ISBN: 1787561712
Category : Social Science
Languages : en
Pages : 304
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Book Description
At a moment when reproduction is increasingly politicized, the volume explores the breadth of contemporary research on reproduction from the perspective of medical sociology, illuminating the lived experience of reproduction and offering insights to inform sociology and health policy.
Author: Brigid McCue
Publisher: Elsevier Health Sciences
ISBN: 0323395759
Category : Medical
Languages : en
Pages : 161
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Book Description
The Ob/Gyn Hospitalist, the newest subspecialist in the field of obstetrics and gynecology, has the potential to improve patient safety, patient and provider satisfaction, workforce challenges and clinical outcomes. Programs are exploding across the country, mirroring the growth of the internal medicine hospitalist programs 10 years ago. Ob/Gyn hospitalist jobs are the most sought after in the field. We will present the history of the Ob/Gyn Hospitalist movement, available evidence to date supporting Ob/Gyn Hospitalists, and where we believe the field is going.
Author: Beth L. Sundstrom
Publisher: Lexington Books
ISBN: 1498503144
Category : Social Science
Languages : en
Pages : 129
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Book Description
Reproductive rights are human rights. Reproductive Justice and Women's Voices: Health Communication across the Lifespan offers an in-depth analysis of women’s reproductive health in a transformative, sociopolitical moment that is redefining women’s access to health care; reducing disparities in maternal and child health is a critical public health goal for the United States. Sundstrom contributes to patient-centered public health by analyzing women’s reproductive health across the lifespan. Four critical body episodes: contraceptive use dynamics, pregnancy, childbirth, and the post-partum period explicate women’s understandings of control and embodiment in the context of technology. Women’s meaning making of each body episode is interrogated in three areas: (1) the physiological experience of reproductive health, (2) perceptions of medicine and the biomedical model, and (3) opinions of mediated messages about reproduction, including new media. Through stories and silence, the women interviewed in this book demand accurate information, including the risks and benefits of health care, and access to reproductive services and technologies. The analysis disrupts the nature/technology dualism and reconceptualizes health outside of the normative processes of menstruation, pregnancy, and childbirth. By talking with women, this study privileges women’s decision-making about reproductive health and offers insight for how women’s partners, families, and health care providers can support them in this process.
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
ISBN: 0309669820
Category : Social Science
Languages : en
Pages : 369
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Book Description
The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.
Author: Sir Sabaratnam Arulkumaran
Publisher: Cambridge University Press
ISBN: 1107472342
Category : Medical
Languages : en
Pages : 429
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Book Description
In light of revised recommendations for intrapartum care, this updated edition reviews best practice in all aspects of labour and delivery.
Author: Robert Black
Publisher: World Bank Publications
ISBN: 1464803684
Category : Medical
Languages : en
Pages : 416
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Book Description
The evaluation of reproductive, maternal, newborn, and child health (RMNCH) by the Disease Control Priorities, Third Edition (DCP3) focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. Volume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The DCP3 evaluation of these conditions produced three key findings: 1. There is significant difficulty in measuring the burden of key conditions such as unintended pregnancy, unsafe abortion, nonsexually transmitted infections, infertility, and violence against women. 2. Investments in the continuum of care can have significant returns for improved and equitable access, health, poverty, and health systems. 3. There is a large difference in how RMNCH conditions affect different income groups; investments in RMNCH can lessen the disparity in terms of both health and financial risk.
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Languages : en
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