Optional vaginal delivery rate - An informative indicator of intrapartum care

OBJECTIVE: To determine whether an "optional" vaginal delivery rate and nov el delivery score would provide informative profiles of intrapartum care. STUDY DESIGN: Prospective survey of all: parturients delivering between Jan uary and December 1996. Deliveries were categorized as standard-vaginal (V- S), optional-vaginal (V-O), standard-cesarean (C-S) or pote ntially avoidab le-cesarean (C-PA) using specific perinatal criteria derived from the liter ature. A weighted equation was developed and applied, generating physician delivery scores, giving "extra credit" for V-O and a "debit" for C-PA: deli very score = [(%V-O x 2) + (%V-S) - (%C-PA)] x 100. RESULTS: V-O rates and delivery scores ranged from 0% to 25% and from 52 to 113, respectively (medians of 9.8% and 92.9). Among the obstetricians (n = 38), a significant inverse correlation was noted between the total C-S rate s and V-O rates (r=-.54, P<.005). The maternal-fetal medicine physicians (n = 6) had high total C-S rates (22-36%) but also had high V-O rates (17.1-2 3.5%) and high delivery scores (82.1-101.5). CONCLUSION: The optional vaginal delivery rate and delivery score are more- informative indicators of intrapartum management acumen than is cesarean se clion rate alone. We suggest incorporating these descriptors into departmen tal qualify assurance programs.