Question about elective RCS and VBAC

Double-Helix, BSN, RN · Apr 7, 2012

It really depends on the doctor covering the patient. Some OB's do not recommend VBACs for their patients (due, I'm assuming, to risk of complications and liability) so they will schedule RCS for their patients.

General anesthesia is not common for c-sections, especially scheduled ones. But I imagine the complication rate would follow the complication rate for any routine procedure done under general anesthesia.

Here's some great information from the American Pregnancy Association regarding RCS and VBAC. It discusses rates of complications as well. There are some additional references at the bottom of the page if you want to research more. VBAC: lady partsl Birth after Cesarean : American Pregnancy Association

You might also find some good information from peer reviewed journals such the Journal of Obstetric, Gynecological and Neonatal Nursing and Obstetric Medicine. Cochrane, Google Scholar and ebscohost are great databases to search.

That's as far as I really feel comfortable going into this topic, as I'm not fully convinced this isn't a request for medical advice.

eden · Apr 7, 2012

We have a high rate of VBAC's here and the rate of complications is lower the a repeat sections. We have very good outcomes for the VBAC's because we have good guidelines as to who is a VBAC candidate and who is not. Our OB's are very experienced with them but there doesn't seem to be the fear about VBAC's that there does in the US.

tntrn, ASN, RN · Apr 7, 2012

Back in the day (I am talking the late 70's and early 80's) we did NO, exactly NO, epidurals or spinals where I worked. We had a 10% primary c/s rate on a high risk population. All our sections were done under general. Our OBs were FAST and we rarely had any kind of complication with mom or baby.

Personally, they would have to knock me out first and THEN place a needle into my back. The idea really creeps me out. I can help witht them, but stay on the mom side of the bed....I can't watch.

Elvish, BSN, DNP, RN, NP · Apr 7, 2012

We almost never do general anesthesia unless it is a true crash and mom didn't have an epidural already in place, or mom is allergic to morphine. Beyond those two set of circumstances, I can't remember the last time we used general.

It's also my experience that we have more complications from repeat c/sections than from VBACs, but so much depends on other factors. (Why did she have her previous section(s)? How many previous sections has she had?) Even in the absence of complications, there is almost always the increased pain and recovery time that comes with having a section. The absolute risk of complications with VBAC is lower than the absolute risk of complications from a section. Most of our VBACs are successful, and I'm proud of that.

If this is a question you have for your (or a friend's) situation, I encourage you (or them) to have a sit-down with the doctor and discuss it.

jujubug · Apr 7, 2012

Thanks for the all the responses. This is just a topic that peaks my interest since it has come up a lot. I don't have L&D experience, but I've come across some OBs that disappointingly seem to have their best interest a priority. I can totally understand their perspective when it comes to defensive medicine and liability, but it just doesn't seem right to coerce/sway patients in to a c/s when it's uncalled for (i.e. pushing for a c/s when the patient is a great candidate for vbac and chooses to vbac). I can't help but to wonder if some OBs are just scalpel -happy and get impatient. I'm just one of those who knows the risks of surgery and would rather not opt for elective surgery unless the benefit out ways the risk. If I were in a situation where I had to choose between an elective c/s and vbac, I would definitely be very selective choosing an OB who is trustworthy and has integrity. I always stress that to women.

jujubug · Apr 8, 2012

What country are you in?

jujubug · Apr 8, 2012

Back in the day (I am talking the late 70's and early 80's) we did NO, exactly NO, epidurals or spinals where I worked. We had a 10% primary c/s rate on a high risk population. All our sections were done under general. Our OBs were FAST and we rarely had any kind of complication with mom or baby.
Personally, they would have to knock me out first and THEN place a needle into my back. The idea really creeps me out. I can help witht them, but stay on the mom side of the bed....I can't watch.

I've heard of occasional occurrences where gen. anesthesia fails to provide complete pain relief in patients during a c/s. Did you experience anything like this in your career in dealing with that many general anesthesia cases?

tntrn, ASN, RN · Apr 8, 2012

I've heard of occasional occurrences where gen. anesthesia fails to provide complete pain relief in patients during a c/s. Did you experience anything like this in your career in dealing with that many general anesthesia cases?

Never. But I can't count the number of times a patient with a spinal or epidural have almost come off the table. And then hear one of the docs say, "it's just a little pressure.". Right.

CloudySue · Apr 10, 2012

This is not my specialty area, but I have personally had a VBAC, several years before I became a nurse. I was going to go ahead w the c/s but around my 8th month I decided that I was not in the mood to go through the (at least) three week recovery period from major surgery. My OB/GYN thoroughly educated me on the benefits and risks, I remember sitting through a self-guided, interactive computer training program which detailed everything. Then I had to sign a bunch of papers stating I knew the risks, etc. The VBAC itself went off without a hitch, recovery time was much shorter and I was always glad I did it. However, during my OB rotation in nursing school, the nurses there were horrified to hear that that I took that risk. The last one they did had ended up in an infant death, and they were banned after that. (I had my baby at a different hospital.) Being a nurse gives you a burden of knowledge that laypeople don't have, but I felt at the time I made a well-informed decision, and I'm glad I tried it.

jujubug · Apr 11, 2012

That's a really neat story. I'm glad you had a good experience.In regards to a previous post about patients almost jumping off the OR table due to pain during a c/s, I remember in clinicals a patient yelled out as soon as the scalpel hit her and they did put her out. But I heard from several people that had an inadequate epidural or spinal but were not put out. I don't understand why they even take a chance when a patient is probably feeling the surgery.