VBAC Questions

1 30 - 35%

2 yes, less then 1 %

3 yes very often I do fell that way but the advocacy has to be tempered with a realistic view point and the safety of the baby in mind. As a nurse my part is to try everything possible to progress labor. If it's not possible to progress labor then I circulate and recover the c/s and try to help my patients emotionally come to terms with the c/s. I feel a little bad for them but have a clear conscious that what was done was right.

4 Stressful is a word that has lost meaning to me in regards to anything having to do with nursing. Nursing is stressful as a given. Bad situations don't raise my stress level they only make me consider how I can best reconcile the situation.

Also this question is a little unclear. Our doc's don't have a time limit for when a VBAC must deliver. If the Vbac is an induction then every attempt is made to get them into labor (safely). If they are spontaneous labor then they follow the same rules as any vag delivery. Patients are given time to deliver if it become obvious labor has stopped we augment, place an IUPC and only do a C/S if the patient has had 2 hours of adequate MVU with no cervical change or if the cervix swells grossly or if fetal distress occurs. Most VBAC patients are pretty well educated on them so they know what to expect. If everything has been done and they still need a c/s I sympathize with them because they didn't get what they wanted but I don't feel bad because a c/s is what is best in that situation.

5 I think VBAC is great. I see it as only slightly more dangerous then a normal vag delivery. If a patient has been educated on the tiny risk VBACs carry then I think they should be encouraged to VBAC.

The main reason VBAC is rare is because it requires an OB in house and "readily available" MDA. It gets a bad rap because doctors try to talk their patients out of them so they don't have to sleep in the hospital.

my answers are in regard to the last hospital I worked at (I've been out of work for about 5 weeks now)

1. What is the C-section rate at your hospital?

primary c-section rate was 11-13%, total c-section rate was around 21%

2. Are VBACs allowed at your facility? If so, what is the VBAC rate? technically no, they weren't allowed as the hospital didn't have anesthesia in-house 24/7 (there was always someone available but they may have been home on call). However some women came in armed with the knowledge that they could refuse a repeat section, and the bigger practice was willing to accomodate these patients (they were, in fact, fighting to allow VBAC again, and they got a lot of flack from the board of directors for "allowing" any VBACs). There were probably about 3 a year, and that hospital did about 800 deliveries a year, total

3. Since C-sections are so prevalent, do you ever feel like you have to play a greater role as an advocate for patients struggling to have a lady partsl delivery? Yes. The smaller practice that did deliveries on that floor had a much higher C-section rate, and there were cases where I felt that if the patient had been in the care of the other practice, they would have delivered lady partslly. There was one patient I cared for of the smaller practice, who had been puching for several hours, midwife called the doc after 2 hours, he came in to evaluate and offered her a c-section before he even checked the station of the baby's head. The patient wanted a chance to deliver lady partslly, so I kept her pushing. After another half hour or so, he felt she hadn't moved the head down at all, so he called in the OR team. We kept changing positions and pushing, and the head finally turned (it had been acynclitic) and moved down significantly, all in the time the doc was on the phone. To cut a long story short, she delivered lady partslly before the OR team arrived, much to the surprise of the doc and the dismay of the OR team, who had been called in from home in the middle of the night!

4. Since access to VBAC-friendly facilities and practitioners is limited, do you ever feel badly when a patient must have a C-section despite their desire to keep trying for a lady partsl delivery? (When the doc says, "Time's up!" but mom wants to wait a few more hours) Is this situation stressful? I had some issues with the doc in the above story, and his partner, but the majority of deliveries I attended were from the bigger practice, a group of women OBs and CNMs who were very respectful of lady partsl birth and made every effort to allow it. As long as mom wanted to keep trying, and sometimes even when mom was ready to give up (they were great cheerleaders, all of them), as long as baby was OK they stayed out of the OR. They were very aware of the effect of a prior c-section on a future pregnancy and practiced to avoid it if possible

5. As a nurse, do you think VBACs are beneficial or dangerous? beneficial, overall, as long as everyone is on board and aware of the risks/benefits involved

I'm also happy to say that the facility I am waiting to hear back on for a job allows VBAC!

Thank you so much to those who have responded. I truly appreciate it! This is a topic that I feel very strongly about, and I would love to hear opinions from as many nurses as possible.

There was an article in the Washington Post on Thursday:

Once a C-Section, Always a C-Section?

Women Who Want to Try Labor on Later Deliveries Are Increasingly Refused

By Rob Stein

Washington Post Staff Writer

Thursday, November 24, 2005; Page A01

When Karri Rickard moved from Pennsylvania to Maryland, it never occurred to her that she would have a problem finding a hospital to deliver her baby. But she did. So much trouble, in fact, that Rickard and her husband are giving up their home in Frederick and moving back to Pittsburgh.

There is some good research and statistics on http://www.ican-online.org.

My hospital does do vbac's, in fact we have a new consent form that basically says that the repeat c-section has higher risks than the vbac.

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