why the anti-VBAC stance in hospitals?

  1. I'm 10 wks prego and had a c-section with my 1st. I very much want to have a VBAC but am told by the doctors that the hospitals won't allow it. is there anything I can do to avoid a c-section (short of a home delivery--just kidding) and still have a hospital delivery (yes, I understand the uterine rupture risk)

    What would you nurses do in my shoes?

    any help understanding this bureaucratical B.S. and how to get around it would be great!

    thanks
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  2. 40 Comments

  3. by   Jolie
    I implore you to seek a second opinion, and follow your doctor's recommendations. Recent studies have demonstrated the risk of uterine rupture to be as high as 1 to 2% for healthy VBAC patients. Please don't risk being one of those 2 patients in 100 who suffers a uterine rupture which could cost you your baby's and your own life, at worse, or, at best, result in a hysterectomy and massive transfusions to save your life. It is among the most devastating events I have witnessed in 11 years of OB.

    I know of an OB who counseled a healthy patient to have a repeat C-section, rather than risk a VBAC. The patient refused to get a second opinion, and when in labor, refused to come into the hospital until the very last minute, so that she could avoid a C-section. As you may have guessed, her uterus ruptured, taking her baby's life. Completely preventable. How sad for all involved.

    I understand your desire for a vaginal delivery, but please don't lose sight of the forest for the trees. The goal of your pregnancy and delivery is not to VBAC, but to give birth to a healthy infant.

    Best wishes.
  4. by   Dayray
    The isssues with hospitals and V-bac are that the stardard of care is to have a full OR staff OBGYN, anestsia, 2nd assist and tech. Immediatly avaliable. The problem is that the rules don't define what immediatly avilable means. doc's dont want to hang out at the hospital waiting for a V-bac. Pit is risky with V-back makeing schedualed induction (for doc's convenence)diffecult. Doc's will say that immedatly available means them being able to be there in 15 min But many of the OBGYN associations are saying that the hospital must provide the abilty to complet a stat section within 15 min from the time it is determined that the patient is rupturing. The liability is laid on the hospital not the doctor.

    I personaly have mixed feelings about V-bac I can see the pros and cons from both sides. I agree that you should seek a second opion. I also would sugest that you use an OBGYN and not a GP and make sure the doctor is comfortable with your choice of V-bac. You should tour hospitals in your area and ask questions about their OR and what their response time is for a stat section
    as well as their V-bac policy.

    Just please don't do what the patient in Jolie's example did. A rupture happens fast and cuases huge blood loss. If your uterus ruptured anywhere but in a hopital near an OR you would most likely die.

    Also please be aware that while home birth is a wonderful option, V-backs are not a good idea at home. It is true that it is only a 3-5% chance that your uterus would rupture but if it did a lay midwife would not be able to save you or your baby and if they tell you they can they are mistaken.
    Last edit by Dayray on Mar 29, '03
  5. by   mark_LD_RN
    it all has to do with increased liability and new ACCOG guide lines.which basically state vbacs are not supportted by accog. for VBAC to be considered last c/s had to be for reason other than CPD,had to be low transverse incision, only 1 uterine surgical incision or c/s. previous vaginal birth. estimated fetal weight less than 8 1/2 pounds. adequate pelvis or proven pelvis. doctor also has to be in house so does anesthesia. stat c/s must be able to be performed with in 15-30.


    the only way around it now is to get second thrid or more opinion until you find a doc willing to try it. we only have 2 docs here that will do it. and only one that will use pitocin during labor which is very controversial.


    hope this helps
  6. by   SmilingBluEyes
    duplicate post, sorry.
    Last edit by SmilingBluEyes on Mar 29, '03
  7. by   SmilingBluEyes
    Originally posted by SmilingBluEyes
    I agree. One of the hospital systems I am employed with does NO VBACS in any of their hospitals. Why? It is simple. Anethesia personnel refuse to be in-house during labor of VBAC patients. Thus, our risk management personnel say "no VBAC's" as this would jeopardize our insurance status and increase potential liability through the roof. It is NOT an anti-VBAC stance by our doctors or us nurses; but without 24/7 require INHOUSE coverage, you are risking too much allowing TOLAC (trial of labor after csection) to occur in a particular institution. It comes down to doctors and anesthesia being in house and dedicated to OB during the entire length of labor of a VBAC patient as to whether or not a VBAC can occur where you plan to deliver.

    And I have to agree; I would NEVER encourage a VBAC candidate to labor at home or even a birth center cause seconds and minutes count in the event a uterus does rupture. Stats I have read indicate ANYone in labor stands roughly a 0.5-1% chance of uterine rupture. A VBAC patient's risk rises to roughly 3-5%. While these numbers may seem low, you best believe they are NOT insignificant, especially if/when they happen to YOU or a loved one. One of the ugliest situations and ensuing law suits I ever heard of involved a uterine rupture of a NON prior csection patient. Remember, her theoretical ris of this was only roughly 1% ( I was not involved but a close coworker was). The mom and her baby survived, due RAPID intervention by the doctor and nursing personnel, but the baby will never live independent of some form of continual life support.

    And yes, death can be imminent to you and the baby if a tear happens. I would NOT trifle with such risks in a NON hospital setting where qualified personnel are NOT IMMEDIATELY available (OB and anesthesia personnel) to deal with it! I wish you the best of luck and a healthy pregnancy and delivery!
  8. by   fergus51
    They can't really stop you from attempting a VBAC if you show up in labor and don't want a c-section for any reason other than maternal or fetal distress. They aren't going to strap you to the stretcher against your will. I would probably try another hospital though. Labor is hard enough in a supportive environment.
  9. by   SnowymtnRN
    Well i just had a repeat c/s, and for my own reasons i chose to do a c/s. However, that said, my doc left it up to me as to whether or not i wanted to attempt a VBAC or not. I'm sorry but 1-2 out of 100 that FAIL at a VBAC is a minute number. If we always "played it safe" in medicine, then there's a lot of things that would be obsolete.

    If you want to attempt a VBAC, the reality of it is what are YOUR odds of having a successful birth? Mine weren't good. My boys were both big, and after a 22 hour labor with no descent, i had to have a c/s with my first. He never did drop, and my labor was textbook, i dialated to a complete 10 in 8 hours, and pushed for 2. My only option was a c/s. With my second son, i had the choice to try a VBAC and chose not to, since my first son never dropped, and was so big, the chances were that would happen again. The last study i read about 6 months ago stated that VBAC's were 85% successful. That's pretty amazing. Just because a c/s may SEEM safe, doesn't mean that a VBAC can't be safe too.

    Get a second opinion. Find out WHY they think a VBAC isn't a good idea. Then decide what the safest best option for you and the baby is. Good luck! Happy birthing!
  10. by   fergus51
    You should also remember there are inherrant risks with a c-section. Neither option is perfect, you just have to decide for yourself and find a doctor who supports your decision.
  11. by   RNonsense
    Originally posted by fergus51
    You should also remember there are inherrant risks with a c-section. Neither option is perfect, you just have to decide for yourself and find a doctor who supports your decision.
    Agree here...and also maybe the hosptial you've chosen is not equipped should something serious occur...
  12. by   HazeK
    "the stardard of care is to have a full OR staff OBGYN, anestsia, 2nd assist and tech."

    "it all has to do with increased liability and new ACCOG guide lines.which basically state vbacs are not supportted by accog. for VBAC to be considered last c/s had to be for reason other than CPD,had to be low transverse incision, only 1 uterine surgical incision or c/s. previous vaginal birth. estimated fetal weight less than 8 1/2 pounds. adequate pelvis or proven pelvis. doctor also has to be in house so does anesthesia. stat c/s must be able to be performed with in 15-30."

    above quotes are from MarkRN & DayRay...and both are correct!

    IF your 1st section was for something other than CPD, arrest of labor....and
    IF you are delivering at a hospital that can have you on the OR table in <5" and delivered in <10" (personally, I think 15-30 is way, way too long)....
    and YOU UNDERSTAND THE CONSEQUENCES of uterine rupture....

    THEN go ahead and try to deliver vaginally.
    We have a few MDs that will even run pit!
    BUT I work where VBAC's are very, very closely watched in labor, with an epidural catheter in place and an OR open and ready "to ward off evil spirits"!

    IF your doctor and hospital are not readly and easily capable to do the same, play it safe and schedule your RCS!

    IF they ARE willing, good luck!

    haze
  13. by   SmilingBluEyes
    I have to agree once again with Haze. The stats are on your side to be sure, and we all respect your choice, whatever it will be. Just understand the potential hazards of each possibility/option and make sure standard of care is met where you deliver---- and then go into it with both eyes open. Those ACOG standards are there for a DARN GOOD REASON! Sincerely Wishing you the best!
    Last edit by SmilingBluEyes on Mar 30, '03
  14. by   Jolie
    I just want to clarify one point from SwnymtnRN's post. The 1-2% statistic I've quoted is not a VBAC failure rate. It is the risk of uterine rupture with healthy VBAC patients.

    Best of luck to you and your baby.

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