For Those Who Offer VBAC...

klone, MSN, RN · Jul 16, 2014

You're right - they changed it in 2010. Prior to that, they recommended that anesthesia be in house 24/7. From 2006 until 2010, I had worked at a smaller community hospital, and that was their reasoning for not allowing TOLACs. I hadn't realized they changed it in 2010, because since then I've always worked at teaching hospitals where TOLAC was encouraged and there are always docs there all the time.

sonicnurse1984 · Jul 20, 2014

In 2010, NIH convened a conference to look at VBAC and TOLAC policies nationwide. One of the conclusions of the consensus panel was that ACOG should change the "immediately available" language in their guidelines in order to increase access to VBAC.

The report states, "Given the low level of evidence for the requirement for "immediately available" surgical and anesthesia personnel in current guidelines, the panel recommends that the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists reassess this requirement with specific reference to other obstetric complications of comparable risk, risk stratification, and in light of limited physician and nursing resources. "

You can look at the whole report here: http://consensus.nih.gov/2010/images/vbac/vbac_statement.pdf

I think it's important to remember that ACOG has one perspective, but that their are lots of smart people out their looking at the data who don't necessarily draw all the same conclusions. That said, hospital policies are likely to follow ACOG and may not dig deeper into what research has actually been done about the safety and risks of TOLAC.

queenanneslace, ADN, MSN, APRN, CNM · Jul 28, 2014

I work in a small, regional hospital that does not have 24/7 OR staff. Our policy is to have OR staff in house during a TOLAC.

I can't imagine (well, I can imagine!) having the OR staff at home and 30 minutes out when/if we needed a STAT c-section.

While ACOG recently changed its stance to allow for rural hospitals without 24/7 OR staffing to offer TOLACs, I would personally prefer to have the capacity to do a STAT c-section STAT. And not in 30 (or so) minutes.

I love it when TOLACs become beautiful, successful, wonderful VBACs. It's nice when that slight increased risk of rupture does not come to light. We can hope that all TOLACs go that way. But we can't always rely on the best-case scenario.

I don't know how a hospital would have a legal leg to stand on in a case where a TOLAC resulted in a uterine rupture and a c-section was delayed because the hospital wasn't staffed to perform an emergency c-section.

30 minutes is a looooooooooooooooooooooooong time.

klone, MSN, RN · Jul 28, 2014

Could you imagine needing a STAT C/S and having OR AND OB staff at home? That's where I worked the first five years of my career.

Sydney2011 · Jul 30, 2014

Realistically, VBAC or not, if it's too risky to deliver without immediate 24/7 access to c-sec then it's too risky for any woman to deliver in a hospital since risks exist for all women in L&D.

I'm an RN and I've had 3 VBACs. I also had insulin-dependent GD.

toomuchbaloney · Jul 30, 2014

http://www.yahoo.com/health/florida-hospital-forces-woman-to-undergo-c-section-93128924277.html

“My decision to allow labor to proceed before consenting to a surgical intervention is based on years of research, careful consideration of the risks to me and my baby, and my family’s needs. All I want is to be able to go to the hospital when I’m in labor and have my medical decisions respected — and my decision is to proceed with a trial of labor and not have cesarean surgery unless some medical complication arises that makes cesarean surgery necessary for my or my baby’s health,” Goodall said in a statement released on her behalf by the National Advocates for Pregnant Women (NAPW).

Rinat Dray sues for forced C-section: Says doctors at Staten Island University Hospital performed the procedure against her will.

The American Congress of Obstetricians and Gynecologists is crystal clear about how they feel about forced C-sections: Their ethics committee says it simply “cannot currently imagine” a situation in which any pregnant woman should be forced by the judicial system or her doctors to have surgery she does not want.* It doesn’t matter if the doctors believe a C-section is in the best interest of the fetus—the mother’s autonomy trumps that.

klone, MSN, RN · Jul 30, 2014

I've watched a fetus die on the monitor because the mother wouldn't consent to a C/S (against their culture). It's awful, but doing surgery on someone against their will is horrifying.