Hello! My name is Mandy David and I am a junior nursing student at the University of North Dakota. I am currently taking a childbearing class and have an expectant mom that I am following, and I have finished my rotation on the OB unit. I joined this listserv a few weeks ago, and I have enjoyed learning about the different topics that have been discussed.
I am very interested in lady partsl birth after cesarean delivery (VBAC) because my expectant mom is attempting it for her second child birth. I didn't know much about it before this year, and I have found some interesting facts on how women are chosen or decide to attempt VBAC and the consequences that may occur because of this attempt.
According to Harer (2002), informed consent is essential for any patient who requests a trial of labor and that patient usually can only have had 1 prior low transverse scar from a previous cesarean. Dauphinee (2004) suggests that women should not be pushed into having a VBAC and that women with more than one should not be discouraged, and that women with prior classical incisions should be strongly discouraged.
Uterine rupture is one of the complications of a VBAC, and it should be carefully watched for in these patients. Although it has a very low occurrence in VBAC patients with only 1 prior cesarean, it is still a risk that can be dangerous to the mother and the baby. There are questions about what the proper detection of uterine rupture are, but according to Block & Toppenberg (2002) prolonged, late, or variable decelerations and bradycardia of the fetal heart rate are the most common signs of uterine rupture.
My questions to you are as follows: Do your units encourage vbac? If so, how do you inform your patients of its risks? Have any of you ever been a part of a vbac that resulted in a uterine rupture? What were the measures taken to protect the mother and the baby?
Thank you in advance for any information! It is greatly appreciated!
Thanks again,
Mandy David, SN
University of North Dakota
References:
Block, W.A. Jr. & Toppenberg, K.S. (2002). Uterine Rupture: What Family Physicians Need to Know. American Family Physician, 66(5), 823-827.
Dauphinee, J.D. (2004). VBAC: Safety for the Patient and the Nurse. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 33(1), 105-115.
Harer, W.B. Jr. (2002). lady partsl Birth After Cesarean Delivery: Current Status. Journal of American Medical Association, 287(20), 2627-2630.
