Why VBAC in Northern New England is still viable: the Northern New England perinatal quality improvement network.

Under the strong leadership of Maternal-Fetal Medicine specialists and the support of the tertiary care centers serving the region, Northern New England (NNE) initiated a collaborative project to improve the availability and safety of trial of labor after cesarean delivery. The project involved over 250 individuals from over 30 organizations and resulted in a strong regional guideline that has been implemented by institutions across the nation. The availability of trial of labor after cesarean in NNE has increased.

Operative vaginal delivery: a comparison of forceps and vacuum for success rate and risk of rectal sphincter injury.

Objective: We investigated the success rate of operative vaginal delivery and risk of rectal sphincter injury when forceps or vacuum was used.

Study Design: Cases were identified by a retrospective review of delivery logbooks and an obstetric database. Rotations were excluded.

Adjustment for case mix in comparisons of cesarean delivery rates: university versus community hospitals in Vermont.

Objective: Our objective was to determine whether case mix model adjustment would help to explain differences in cesarean delivery rates between community and university hospitals. We also wished to define a patient population in which the cesarean delivery rate would be more reflective of individual practice patterns than of obstetric or medical risk.

Study Design: Established risk factors for cesarean delivery were identified by retrospective chart review at two community hospitals (designated A and B) and a university hospital.