The immediately available physician standard.

The promulgation of the immediately available physician standard has contributed to the rapid decline in vaginal birth after cesareans (VBACs). While having an immediately available obstetrician during a VBAC trial will reduce risk, it is not clear that similar advantage wouldn't also accrue to women without uterine scars. However, many hospitals can't staff up to that standard. In this article we suggest 1) set a goal of providing an immediately available team for all women in labor, 2) tailor informed consent to women's unique risks- unique because of their own risk profile (e.g., previous scar, hypertension, etc) or unique because of characteristics of the birthing site (e.g. a team is or is not available), 3) in smaller hospitals, if an immediately available team cannot be routinely provided, consideration should be given to bringing in a team for the occasional patient requesting a trial, and to allowing labor for lower risk trials.