VBAC and Protocols

We DO allow VBACs at our hospital. The following conditions apply:

No prior verticle uterine incision. If a patient presents who is unknown and without a prenatal record, who has had a prior csection-----we will attempt to get an operative report----if we cannot obtain a copy of her operative report, she cannot TOLAC (trial of labor after csection) at all.

All personnel must be IN HOUSE to include: The obstetrician, anesthesiologist dedicated to THIS case, and of course, all nursing/techs (if we have a nurse home oncall, she will be called in).

Continuous fetal monitoring is a must. No exceptions.

A saline lock is started (not necessarily an IV) but access is mandatory.

Type and Screen are drawn and held in our lab.

NO prostaglandins are to be used (cytotec, prostin gel, cervidil etc) and pitocin augmentation VERY cautiously and preferably, with internal monitoring. It is preferred NO augmentation is used.

Of course, specific consent to VBAC with risks spelled out, is signed by patient prior to beginning.

this is basically our protocol/policy. HTH.

TOL/VBACs are "allowed" but the issue is that all physicians are not willing to do them.

We have a LARGE percentage of Hispanic pts who've had C/S in Mexico, with unknown uterine scars. The skin scars are vertical. We DO NOT VBAC these women. No way, no how.

Those pts who've had sections with known medical and surgical histories and are pro VBAC sign a consent for TOL.

All our pt's have IVs at least at TKO.

No ripening agents: no Cervidil, Cytotec, PGE-2.

Pitocin may be considered if amniotomy does not bring UCs on better.

Pitocin, if used, is "low dose": no greater than 8 mu/min, usually...and they are bumped up very slowly.

If ruptured, we (nurses) internalize them (use FSE and IUPC)

They are on continuous fetal monitoring anyway, even if not SROM/AROM

Our hospital always has 24 hour in house OB and 24 hour in house anesthesia.

Technically, we are supposed to say to pt.'s that we do not permit VBAC's. This is so the ob docs can draw up an policy on the issue. Nevertheless, VBAC's are still done by one practice. Yes, we have a huge disclaimer form that the pt. must initial each statement and sign. The ob doc and anesthesia must be present throughout the duration.

IMO, the real reason why there is a push to ban VBAC's in our hospital is because of the inconvienence it brings to the OB doc to have to stay with the laboring mom. I hope and plan to VBAC with this preg. Many of the nurses on our unit are fighting hard to allow women that right.

Technically, we are supposed to say to pt.'s that we do not permit VBAC's. This is so the ob docs can draw up an policy on the issue. Nevertheless, VBAC's are still done by one practice. Yes, we have a huge disclaimer form that the pt. must initial each statement and sign. The ob doc and anesthesia must be present throughout the duration.

IMO, the real reason why there is a push to ban VBAC's in our hospital is because of the inconvienence it brings to the OB doc to have to stay with the laboring mom. I hope and plan to VBAC with this preg. Many of the nurses on our unit are fighting hard to allow women that right.

Unfortunately, all the disclaimers in the world won't protect an OB doc in a lawsuit. Where do moms with bad outcomes go, regardless of cause or fault? To an attorney. Unfortunate, but it's really that simple.