No more VBACs allowed?

Specialties Ob/Gyn

Published

Just read this mornings paper and the front page has a large article about our local hospital no longer allowing VBACs. Now, I find ths hard to believe given that two of my patients over the past weekend were VBACs but ... what? The didn't interview any local docs (or CNMs that work with them) but they did, ironically, interview the one LM in town. Of course, I haven't been in to work yet and don't want to call and start nagging so the paper may well be exaggerating his situation. The thing is, I work PP as a tech right now and will be moving to L&D in four months when I graduate. I can't imagine saying "no" to every VBAC ... our section rate is already astronomical! And on top of all of this ... I'm planning on getting pregnant this summer after school is over and I was a section 13 years ago ... and I may want a VBAC! I don't like that the decision has been made for me ... I've heard of this happening in bigger hospitals and never thought it would happen in my town. HMPH! I just don't know what to think.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It's becoming more and more common, as risk managers look at the catastrophic potential and decide it's not in the hospital's best interests to provide this option (TOLAC/VBAC). Also, an issue is that of in-house 24/7 dedicated anesthesia coverage. Not all places are in a position to provide this, and it is standard of care for TOLAC/VBAC. I would expect to see even more hospitals discontinue VBAC as time goes by. The risks are just too high for many to want to assume (doctors and hospitals). Until there is some sort of reform or cap on suits, this and many other such trends will continue, unabated.

Up Vote Up Vote ×

I think it's terrible because it IS NOT based on real research. VBACs have been shown to be safe in most women (I am not talking about those needing pitocin, etc) but the fear of litigation is starting to control EVERYTHING in L&D nowadays. I can't imagine wanting to go back into L&D unless I go back to Canada.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

no it's not based on valid research..... but it is what it is. Assuming ahead of time, the risk for even ONE catastrophe---it is too much for most risk managers to consider. And yes, I have seen a uterine rupture in TOLAC ONCE in 7 years. RARE but catastrophic. It's about risk assumption and law, not research, as you know Fergus. And so the trend will continue until law suit caps/reform come into being. WE see more and more often, despite excellent informed consent, law suits being initiated and winning in such cases. So fewer hospitals and doctors want to take the risk. Can't blame them, really.

Up Vote Up Vote ×

That's my problem with L&D, particularly in the US. They look at the risks of one thing, but ignore the risks associated with the alternative. C-sections aren't minor as you know, and I just don't see the benefit in forcing women to have sections rather than allow them a VBAC when the evidence is that it's a safe option for most. I can't stand the CYA mentality of medicine. I'm not saying it isn't becoming more and more common in Canada (because it is), but I can't think of the last time I worked a shift here without hearing some mention of litigation. It's completely out of control.

Up Vote Up Vote ×

Our docs are already up their eyeballs in payments, so they say no more VBAC's unless mom comes in crowning or signs off on all the risks. They told us someone in S.CA recently got a HUGE settlement and they just can't risk it. They are now discouraging VBAC's for fear of lawsuits NOT because they are inherently unsafe. We have no inhouse anesthesia after hours, so if we do a VBAC that goes bad we are scr*wed. It is sad, but if those docs leave OB, we will get no more. PA is in a HUGE malpractice crisis and no doctors one want to come here.

Up Vote Up Vote ×
Specializes in NICU, PICU, educator.

Wow...but what if the mom refuses to have another section unless there is a medical reason? How do they get around that?

I agree....litigation is controlling way too much. We are seeing a lot of it in NICU too because of the fear of someone suing over something. It has gotten so out of hand.

Up Vote Up Vote ×

Our doctors will refer a patient to another hospital, about 20 miles away that has 24/7 in house ob, ped, and anesthesia. If patient comes in and refuses, we have a waiver and doctor writes huge note pt was advised re. risk of VBAC, etc., etc.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

If a patient were to refuse a csection (as is her right), she would have to AMA either out of the hospital (if stable) or sign AMA to proceed to deliver lady partslly. Sadly, even that won't necessarily protect anyone in the event of a catastrophe from lawsuit. Again, til reform comes, this is how it is. I don't like it; don't agree with it; but it is what it is. Sad. It's a lottery for some people, and ruins it for those who have legitimate complaints.

Up Vote Up Vote ×

And let's have some more insurance regulation while we're at it. Those companies aren't going to lower rates on their own.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

You read my next thought, fergus. Glad to see you are back in business...rofl. Insurance reform is IN DEFINATE ORDER!

Up Vote Up Vote ×
:D Deb, it gave me comfort to know that while my phone line was out you'd be here expressing my thoughts...
Up Vote Up Vote ×
+ Add a Comment