VBAC's

  1. Its better to remain silent and thought a fool then to speak out and
    remove all doubt-Ben Franklin

    At my hospital we deliver about 600 babies a year and still have 2 General Practitioners delivering. ACOGG has recently come out with new recomendations regarding VBAC's which states that a
    physician able to perform a stat section be immed. available (in house) during the duration of the labor. We do not have anesthesia in house 24/7 but on call and expected to arrive within 10 mins of notification (ya right!). Anyway my question is how are other facilities handling this? Are smaller community hospitals doing VBAC's? If so do you have a policy and procedure that you could share. Its unfortunate but we are thinking of not attempting VBAC's because of this recommendation and the possible legalities involved.
    •  
  2. 18 Comments

  3. by   indynurse
    We are a smaller hospital, but not in a rural area. We always have anesthesia, OB and neonatolgist in-house at all times.
    I wouldn't want to work with any less available. The other day we had a VBAC laboring. She was doing great. Then she started having RLQ pain through her epidural. At first her doctor (an OB) just thought it was a "hot spot". About 30 minutes later, the baby's FHT dropped into the 60's and stayed there. We STAT sectioned her and guess what we found. Yep, you guessed it. Her uterus had ruptured along her old incision line. The stars had all aligned for this woman and everything turned out fine. Baby even came out with apgars of 8/9 and went to well-born nursery. This woman already had an epidural in place and her OB was on the unit (it was lunch break at his office) when the baby's heart rate dropped. The baby was out within 10 minutes. I can't imagine if we had to wait 10 minutes before anesthesia was there.
  4. by   SmilingBluEyes
    In the one hospital I work, If we do VBAC's, anesthesia and the OB/GYN must be IN HOUSE the entire duration of labor thru delivery. period. And ped is oncall. the other hospital I work at, does not do VBAC's at all, period. These ladies must go to the Level 3 hosp in the system, 8 miles up the road. They got out of that business a while ago.
  5. by   mother/babyRN
    We DID do vbacs all the time and the deal was that anesthesia (who did not and does not have to be there 24/7) had to come in, as they would if there was an epidural. NOW the literature is against VBACS so the docs who supported them in the past do not advise them now...Just as well in my opinion...I was not happy being pressured into being one, after having experienced both, for me the section was by far the easier and less painful...When you have seen one ruptured uterus, you've seen them all. I feel badly for the people who DO want to VBAC and are talked out of it by their docs since, based on the most current literature the docs are reading, they say it isn't a good idea....Will be totally different by next month and the next article...
  6. by   shay
    We have OB, anes., and surgical team in house until VBAC is delivered. Yep, sucks to be them, but better safe than sorry!!!
  7. by   mother/babyRN
    That IS their freaking job, after all...Ticks me off. WE have to be there!
  8. by   anitame
    At our small community hospital (40-50/month) we require the OB, anesthesia and the or crew to be in houes once the patient is "active". They must also have a 16!!! gauge catheter.
  9. by   SmilingBluEyes
    16 ouch....
    we ARE the team where I work....since we do our own sections..so just having anesthesia and the OB in house works just fine.
  10. by   shay
    BluEyes, I am jealous. Where I used to work, we scrubbed/circulated our own c/s. Now the OR team does it where I am now. So annoying to have to depend on them. I hate it.
  11. by   L&D.RN
    I just had a beautiful VBAC last night. G4P3 that was sectioned 1st time for FIL...was induced with pit for her 2nd child, natural with the 3rd, and natural last night. That's the first time I've seen them let the pt go without having the epidural catheder placed ahead of time though.

    We have to have anethesia and OB inhouse when pt becomes active. Peds needs to be within 15 minutes.
  12. by   BugRN
    Mother/Baby/RN
    I was shocked to hear about VBACs not being the way to go anymore. When did this happen??? I know there is always that risk of uterine rupture, have even seen it, but across the board decisions prefering not to do them at all?? I hadn't heard that. It's amazing how fast it all changes isn't it.
  13. by   at your cervix
    A couple of or docs and some nurses had this discussion not long ago. I guess it depends on how you interpret "immediately avaliable". All of our docs can be to the hospital within 5 min if they are at home or at their office, therefore, they feel that this is immediate enough, therefore, we don't have the ob in house for vbacs. We also do our own sections so we don't have an OR team, and anesthesia is also "immedieately avaliable" at home. If the pt has an epidural then anesth is of course in house, otherwise they may or may not be, depending on what is happening in the OR. We do approx 160 births per month.
  14. by   mother/babyRN
    Our OB chief has recently become quite wary of VBACs due to recent literature coming across the boards. He used to almost INSIST that I try to VBAC it ( I was having none of it)...It is weird how things change, but don't forget, we are not a metropolitan center where anesthesia is always around so that might impact on his thoughts, though I have noticed everyone else is down playing them also....I will have to ask him (the Chief) what the deal is with the new thinking. He is usually up to date with new stuff....

close