Info on VBAC please

  1. Hi there fellow nurses! Just wondering what you can tell me about VBAC. I am pregnant with our third child and want to try it. I had a vaginal with my first (7lbs, 0oz..was induced at 42 weeks, had a 3rd degree episiotomy). With my second I went into labor on the due date but would not progress past 4 cm. with pitocin after 13 hours. Apparently the baby (8lbs, 13 oz)didn't even engage into my pelvis so I had a C-section (low transverse). I ended up getting endometritis and the whole experience was miserable. I have read the ACOG recommendations but wanted to hear from your experiences-what you've seen and heard about it. Thanks!
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  2. 11 Comments

  3. by   fergus51
    I have read that up to 80% of women can successfully have a VBAC. I would be uncomfortable with them being induced or augmented, they usually have an IV, and I monitor them more closely. It is very possible to have a nice VBAC. That said I have them completely ready for a c-section just in case. I have had some VBACs that we call a "very bad accident coming"
  4. by   RNonsense
    I myself have had 3 sections...after the first I did discuss a VBAC with my OB/GYN, but my risk of rupture was pretty high and the hospital I wanted to deliver at close to home was not equipped to handle that.
    Best of luck to you either way you choose! When is your due date?
  5. by   SmilingBluEyes
    You really need to direct this question to your primary care provider (OB or midwife). Some hospitals (I work in one of them), refuse to do VBAC's....this is partly due to not having A *dedicated* anesthsiologist for OBSTETRIC CASES only....or that there is no OB/GYN in-house at all times. Also, you need to know the midwife/OB in charge of your care is comfortable with doing this in your case.

    I have taken care of quite a few labor patients undergoing VBAC with success. (The other hospital I work DOES DO VBAC's). They were pleased, as were we. The risk of rupture is still theoretically small, about 2-3% (versus 1% with ANY labor patient) but that theoretical statistic is still sobering to many--- as it is 1-2 TIMES HIGHER (100-200% greater) than with NON-VBAC cases. How comfortable is your care provider with this? You need to find out.

    It sounds as if with the kind of incision you have, it is very possible you could successfully VBAC. I have seen it and know it is very possible. But it would be a bit inappropriate to say what is possible or not in YOUR case because I don't know you and your history and know not the hospital/birth center at which you have chosen to have your baby. These are the people who can best help you decide the best course of action.

    Find out: in the case you pursue VBAC will your doctor/midwife be IN- HOUSE THE ENTIRE DURATION OF YOUR LABOR (this is safest and mandatory in many places). Also, are there DEDICATED ANESTHESIOLOGY STAFF available IMMEDIATELY in the case an emergency should arise? THIS IS A MUST!

    I wish you a healthy pregnancy, delivery, and baby. GOOD LUCK!
    Last edit by SmilingBluEyes on Jan 5, '03
  6. by   luv l&d
    We do vbac's at our place and induce them also. We use prostin, no cytotec, and will use pit to induce and augment. Note, they do have iv access and we have 24 hr anethesia coverage and an Ob on deck at all time. Have about a 60 % success rate and have seen 2-4 ruptures in 23 yrs.
  7. by   BeachNurse
    Thanks for the helpful replies! I did speak to my doctor earlier in my pregnancy about it and he seemed to feel that if the baby was around 8lbs that it would be safer to go for the repeat c-sec, especially if my cervix wasn't doing anything. I have an appt. tomorrow morning and I will discuss it further with him then. I want to do what is safest for the baby. I forgot to mention that my C-section took place in May 1995, so the scar is probably well-healed. I am due April 6th!

    Thanks again..
    Last edit by BeachNurse on Jan 5, '03
  8. by   kittyw
    It can be done, but just be careful ... I hope you're gonna be at a good hospital with a good ob doc.

    My best friend tried it ... her first son was 9lbs 8oz. Her doc did an ultrasound the day before induction, and said her second baby should be around 7-8lbs. So they tried a VBAC. She was induced, on pitocin for 10 hours - never got past 4cm. She started to complain of a sharp tearing pain. The doctor ignored this. Then the fetal heart stopped, she ruptured - ended up with a csection, fortunately her 11lbs 7oz baby was revived... she had an emergent hysterectomy. It was a very scary time for all of us... fortunately she wasn't planning on any additional children.

    I really think a good doc wouldn't have let this progress as far as it did before doing the csection .... just something to consider when talking to your doc.

    Good luck with you're new baby!
  9. by   hoolahan
    I had a VBAC for my second, and I wouldn't have it any other way. It was sooooo much better than the section, which was a completely horrible experience from a epidural that didn't take to the delayed bonding w my son, to the pain or the surgery, to the ugly scar I still have.

    I would definitely investigate it, and if you are a good candidate, be sure you go to the hospital that has done them.

    Even tho I beld like a PIG after the VBAC, I felt like a million bucks as soon as that kids was popped out! I was also induced , on Pit for about 6 hrs before delivery w no adverse effects.

    Congrats on the baby!!
  10. by   MomNRN
    The hospital I delivered at and previously worked at recently established a VBAC team. This is a group of nurses who took specialized training and who agree to be called in should a VBAC be admitted. It goes along with the anesthesiologist in house as well as the OR team must be on call, and in house within 10-15 minutes should an emergency arise. There is extra paperwork required so mother is informed of risks involved.
  11. by   SmilingBluEyes
    Originally posted by MomNRN
    The hospital I delivered at and previously worked at recently established a VBAC team. This is a group of nurses who took specialized training and who agree to be called in should a VBAC be admitted. It goes along with the anesthesiologist in house as well as the OR team must be on call, and in house within 10-15 minutes should an emergency arise. There is extra paperwork required so mother is informed of risks involved.
    g

    Great concept, but I want to ask. If they had the vision and imagination to establish a special VBAC team why on EARTH did they NOT do their OWN csections? That an OR team is 10-15 minutes out is not good enough, really, in certain cases. Just curious?
  12. by   Love4Me
    Personally, my first son was born via (emergency) c-section, the second was natural, the third was also natural (10lbs 12oz), and the fourth was also natural after being induced with cytotec (was a stillbirth). I had no problems with any of the VBACs. However, I don't think you should go by any experiences I or anyone else have had. Follow your doctor's judgement.

    Best of Wishes to you!
  13. by   BeachNurse
    Hi again..after speaking with my doctor today and discussing it with my husband, I think I will go ahead and schedule a repeat section. My doctor says I can always cancel it if for some reason I change my mind. I really appreciate everyone's input!

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