Table 3 Summary of studies – provider-level interventions
From: Adjunct clinical interventions that influence vaginal birth after cesarean rates: systematic review
Study; Design; Country, setting; Funding | Population; Study period | Intervention & comparator (no. of participants) | TOLAC ratea | VBAC ratea | VBAC/TOLAC ratea | Study; Design; Country, setting; Funding | |
|---|---|---|---|---|---|---|---|
Feldman (2015) Cross-sectional US, community hospitals Non-industry funded | Women with live-born, singleton, vertex gestations, with prior CS January 2012–January 2014 | I: hospitals employing laborists (≥1 physician in hospital, primary focus is to care for patients in labor and delivery) (n = 2621) | C: hospitals without laborists (n = 2111) | I: 356 (13.6%) C: 201 (9.5%), p = 0.0318 | I: 253 (9.7%) C: 137 (6.5%), p = 0.0302 | I: 253 (71.0%) C: 136 (67.9%), p = 0.2943 | |
Lomas (1991) RCT, 3-arm Canada, community hospitals Non-industry funded | Study site inclusion needed 100 beds (10+ obstetrical), no status as teaching institution, not in county with teaching institution 1988–1989 | I 1: audit and feedback (n = 524) | I 2: opinion leader education (n = 739) | C: eight control hospitals, practice guideline mailed to obstetrical care (n = 1233) | I 1: 112 (21.4%) I 2: 282 (38.2%) C: 349 (28.3%), p = 0.007 | I 1: 62 (11.8%) I 2: 187 (25.3%) C: 179 (14.5%), p = 0.003 | I 1: 62 (55.4%) I 2: 187 (66.3%) C: 179 (51.3%) |
Myers (1993) Follow-up to non-concurrent cohort (1985–1987) US, level 3 prenatal center Funding NR | All patients in obstetric department 1985–1991 | Grp 1 (1985): before hospital initiative (n = 122) | Grp 2 (1986–1991): after hospital initiative; 2nd opinion required for all CS, VD was preferred, dystocia accepted as indication for CD (n = 1840) | 1985: 55 (45.0%) vs. 1986: 132 (68.4%) 1987: 233 (86.0%) 1988: 243 (88.3%) 1989: 255 (91.3%) 1990: 312 (85.4%) 1991:374 (81.8%) | 1985: 29 (23.8%) vs. 1986: 106 (54.9%) 1987: 162 (59.8%) 1988: 167 (60.1%) 1989: 188 (67.4%) 1990: 242 (66.3%) 1991: 291 (63.7%) | 1985: 29 (52.7%) vs. 1986: 106 (80.3%) 1987: 162 (69.5%) 1988: 167 (73.7%) 1989: 188 (73.7%) 1990: 242 (77.5%) 1991: 291 (77.8%) | |