my answers are in regard to the last hospital I worked at (I've been out of work for about 5 weeks now)
1. What is the C-section rate at your hospital?
primary c-section rate was 11-13%, total c-section rate was around 21%
2. Are VBACs allowed at your facility? If so, what is the VBAC rate? technically no, they weren't allowed as the hospital didn't have anesthesia in-house 24/7 (there was always someone available but they may have been home on call). However some women came in armed with the knowledge that they could refuse a repeat section, and the bigger practice was willing to accomodate these patients (they were, in fact, fighting to allow VBAC again, and they got a lot of flack from the board of directors for "allowing" any VBACs). There were probably about 3 a year, and that hospital did about 800 deliveries a year, total
3. Since C-sections are so prevalent, do you ever feel like you have to play a greater role as an advocate for patients struggling to have a vaginal delivery? Yes. The smaller practice that did deliveries on that floor had a much higher C-section rate, and there were cases where I felt that if the patient had been in the care of the other practice, they would have delivered vaginally. There was one patient I cared for of the smaller practice, who had been puching for several hours, midwife called the doc after 2 hours, he came in to evaluate and offered her a c-section before he even checked the station of the baby's head. The patient wanted a chance to deliver vaginally, so I kept her pushing. After another half hour or so, he felt she hadn't moved the head down at all, so he called in the OR team. We kept changing positions and pushing, and the head finally turned (it had been acynclitic) and moved down significantly, all in the time the doc was on the phone. To cut a long story short, she delivered vaginally before the OR team arrived, much to the surprise of the doc and the dismay of the OR team, who had been called in from home in the middle of the night!
4. Since access to VBAC-friendly facilities and practitioners is limited, do you ever feel badly when a patient must have a C-section despite their desire to keep trying for a vaginal delivery? (When the doc says, "Time's up!" but mom wants to wait a few more hours) Is this situation stressful? I had some issues with the doc in the above story, and his partner, but the majority of deliveries I attended were from the bigger practice, a group of women OBs and CNMs who were very respectful of vaginal birth and made every effort to allow it. As long as mom wanted to keep trying, and sometimes even when mom was ready to give up (they were great cheerleaders, all of them), as long as baby was OK they stayed out of the OR. They were very aware of the effect of a prior c-section on a future pregnancy and practiced to avoid it if possible
5. As a nurse, do you think VBACs are beneficial or dangerous? beneficial, overall, as long as everyone is on board and aware of the risks/benefits involved
I'm also happy to say that the facility I am waiting to hear back on for a job allows VBAC!