For Those Who Offer VBAC...

Specialties Ob/Gyn

Published

Specializes in OB.

I am particularly interested in your policies for supporting VBAC deliveries if you work in a smaller, community hospital. Do you require surgeon/anesthesia/surgery staff to be in house throughout the entire labor? How have your outcomes been? Patient response?

Thank you for any feedback you can offer.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Per ACOG recommendations, TOLACs should only be offered if there is in-house anesthesia 24/7

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

I'm dying to know where you work, btw. Everything you've ever described about your workplace sounds VERY much like I worked when I started in L&D in AZ.

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Specializes in L&D/Maternity nursing.

Yes we have anesthesia in house 24/7. Our OB has to physically be house too, not at home (most are good about staying anytime they have labors or inductions over night anyway). They're typed and crossed and we get baseline labs (CBC). Continuous EFM.

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Specializes in L&D/Maternity nursing.

Our VBAC rate is consistently in the upper 70-low 80%. I just wish more would opt to TOLAC.

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Specializes in OB.

I am in Indiana. We have a very small unit (450-500 births per year) and have not done VBAC for many years. We used to do them, with good outcomes, but that was in the mid-late 90s... We currently have a similar protocol for all twin deliveries (anesthesia, surgeon, surgery staff in house once active labor, etc.), but have had resistance about bringing VBACs back, due to the inconvenience and expense of all that. We have to turn women who want this option away, which makes me crazy. We have a good reputation as a place that offers many options (MDs, CNMs, low intervention, natural birth support, water births, etc.), but we are sorely missing VBACs as an option. Trying to get some examples of places who manage to offer it, so I can push for it one more time.

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I VBAC'd at Winnie Palmer in Orlando where there are always anesthesiologists and doctors in house anyways

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We do VBACs at our hospital (300 deliveries/month, NICU, Level 1 trauma center) I guess I should say some docs do, but not all will accept VBACs. We have a STORQ doctor in house 24/7 (who covers all pts in an emergency, their groups' pts, or un-doctored pts that come in) So it doesn't have to be THEIR OB that is in house, but the fact that we have one if we need one covers them. We have anesthesia in house 24/7- one, and mostly they are sleeping at night :-) Continuous monitoring is required. They cannot get Pitocin for induction or augmentation. I think that covers everything specific to our VBACs...

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Pit is okay with a TOLAC per ACOG guidelines, but no prostaglandins.

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Specializes in L&D, PP, Nursery.

We just adopted a policy that OB must be in house. Needless to say we don't do them. Small community hospital here.

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Specializes in MedSurg, PACU, Maternal/Child Health.

Thats unfortunate. So if a woman had one C/S she is stuck with more C/Ss in the future. And I have seen some C/S done for reasons that dont make sense such as a 37yr old mom with no medical issues having her first baby and she was full dilated at +1 station for close to 3 hours... they C/S her because "arrest of descent". There was no fetal distress. The MD just did not want to wait. Same for other patients of different ages (14 to 40) that were making slow progress... Ie in 8 hours their VE change from 2cm to 4cm. Also no medical issues and nonfetal issues...they called those cases "arrest of labor". Their notes always state a legitimate sounding reason for the C/S but if you look at the whole picture it makes no sense. Well I would think for someone having their first baby or having their 2nd or 3rd baby with the last baby being over 15 yrs ago, they are no required to delivery quickly. Some MDs are more C/S happy than others. And C/Ss carry a lot more complications after than VDs. Not to mention that keeping women on their backs all during labor process does not really help them make much progress.

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Specializes in OB.

Actually, ACOG does not state that anesthesia, etc. must be in house for VBAC... It says that they recommend it be undertaken in facilities with staff immediately available to provide emergency care, but that in a facility with resources not immediately available, providers should discuss the hospital's resources and availability of specific staff as part of the discussion of risks and benefits and the patients should be allowed to accept certain levels of risk. (Taken almost verbatim from ACOG Practice Bulletin.)

I mean, really, women accept much greater risks all the time in L & D. Unfortunately, they are usually just not informed of those risks, i.e. inductions, epidurals, and cesareans! Who has ever heard a woman being informed that she will be at higher risk of placental abnormalities, hemorrhage, etc. in her future pregnancies, after having a cesarean for this baby? Ugh.

Our OB committee is about to take this issue up. Again. Wish us luck!

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