[HappyNurse2005]

I hear alot about ladies not being allowed to attempt VBAC's at their particular hospital and wonder how common this is.



All of our OB groups, the clinic that the OB residents work at, and even the family practice group does VBAC's

[BabyRN2Be]

Yes, we do VBACs but only under certain conditions. We have in-house anesthesia and a full-time resident in-house. Not that they end up as being VBAC, but they do REALLY try.

[HappyNurse2005]

yeah, we also always have in house anesthesia, attending docs and residents

[SmilingBluEyes]

allowed.....

If No hx of more than 1 previous c/s or classical internal incision (or unknown history/incision)

Obstetrician and MDA must be in-house during entire active labor process of any VBAC candidate.

link to ACOG VBAC GUIDELINE bulletin we follow:

Practice Guidelines - October 1, 2004 - American Family Physician

"According to the report, the evidence suggests that most patients who have had a low-transverse uterine incision from a previous cesarean delivery and who have no contraindications for vaginal birth are candidates for a trial of labor. Criteria for selecting candidates for VBAC include the following: (1) one previous low-transverse cesarean delivery; (2) clinically adequate pelvis; (3) no other uterine scars or previous rupture; (4) a physician immediately available throughout active labor who is capable of monitoring labor and performing an emergency cesarean delivery; and (5) the availability of anesthesia and personnel for emergency cesarean delivery..."

Summary:
The following recommendations are based on good and consistent scientific evidence (Strength of Recommendation Taxonomy [SORT] = A; see page 1201 for an explanation of SORT):

• Most women with one previous cesarean delivery with a low-transverse incision are candidates for VBAC and should be counseled about VBAC and offered a trial of labor.

• Epidural anesthesia may be used for VBAC.

The following recommendations are based on limited or inconsistent scientific evidence (SORT = B):

• Women with a vertical incision within the lower uterine segment that does not extend into the fundus are candidates for VBAC.

• The use of prostaglandins for cervical ripening or induction of labor in most women with a previous cesarean delivery should be discouraged.

The following recommendations are based primarily on consensus and expert opinion (SORT = C):

• Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.

• After thorough counseling that weighs the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat cesarean delivery should be made by the patient and her physician. This discussion should be documented in the medical record.

• Vaginal birth after a previous cesarean delivery is contraindicated in women with a previous classical uterine incision or extensive transfundal uterine surgery.

[snikki28]

We do not, nor many of the other local Level one hospitals. Liability issues is what I'm told. Although I had two VBACS 15-16 yrs ago, this same hospital no longer does them.

Nicole

[Marie_LPN, RN]

No, we don't.

[htrn]

Yes, we do them - heck, our docs will even do pitocin inductions on VBACs.

I, personally, had 2 c-sections then 2 sucessful VBACs. Even had several versions on #3 prior to going into labor. That was before I bacame a nurse - boy, if I knew then what I know now.......

[shortstuff31117]

Well I havent started my OB job yet, but because I want a vbac in the future I know that the hospital I will be working at does "allow" them. However, it is only one practice of OB's and I hear they have a lot of rules, such as you must go into labor by your due date. So I'm figuring they dont do a lot of vbacs. The other bigger hospital in town, with the better NICU, does not allow them....makes sense right? I'll be going an hour north to have my vbac.

Carrie

[Spidey's mom]

Nope.


steph

[JaneyW]

We are a teaching hopsital with 24 hour coverage and the ability to do true 10 minute crashes. Yes, we do them regularly. My last hospital didn't, but they also didn't have 24 hour anything.