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VBAC

CNM   (1,843 Views | 7 Replies)

mommy2boysaz has 10 years experience and specializes in OB.

9,384 Profile Views; 288 Posts

I am particularly interested in your facility's policies for supporting VBAC deliveries if you are in a smaller, community hospital. Do you require surgeon/anesthesia/surgery staff to be in house throughout the entire labor? How have your outcomes been? Patient response?

Thank you for any feedback you can offer.

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RNIBCLC specializes in Maternity.

1 Article; 357 Posts; 7,599 Profile Views

In my hospital, both anesthesia and OB have to stay in house until a VBAC delivers. We don't have 24 hour anesthesia and so they go home until we call for a epidural, csection, VBAC is needed. Also of course for any off hours surgery. Our patients do fine. We don't get too many though. It seems the pendulum is swinging back again and VBACs are not as popular as they once were. I don't know if this helps you but that's what my facilities policy is at present.

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mommy2boysaz has 10 years experience and specializes in OB.

288 Posts; 9,384 Profile Views

Thank you. This is helpful. May I ask what state you are in? Do VBACs tend to get induced a lot to ensure day time delivery? Is there a lot of push-back from the folks that have to stay in house to wait for the delivery?

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RNMSN51 has 25 years experience and specializes in Na.

77 Posts; 3,031 Profile Views

I'm in Texas. VBACs are never induced, it's contraindicated per hospital policy. They have to do it on their own or get sectioned. As far as push back, I'm sure that they don't like it but it's the rules and if they complain, their told they can practice elsewhere. My hospital is not physician driven so temper tantrums etc are not tolerated.

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RNIBCLC specializes in Maternity.

1 Article; 357 Posts; 7,599 Profile Views

We also do not induce VBACs. I have not heard of any complaints but as pp said, I'm sure they would prefer to be home especially during early labor but per policy they must be in house. I'm in Texas as well.

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LibraSunCNM has 10 years experience as a MSN and specializes in OB.

1,373 Posts; 25,646 Profile Views

I'm a CNM at a smallish community hospital in the NYC area. We are a city hospital, with no private practices, so all CNMs and MDs are employees of the hospital and do shift work. At any given time, there is 1 OB attending and 2 CNMs, and we have 24 hour OB anesthesia, so staffing requirements for VBACs are a non-issue in that sense. We induce VBACs if needed medically, but do not use Cytotec for those inductions. Our rate of successful VBAC is decent, I believe about 65%. Could be better but it seems like we're way ahead of the game compared to a lot of other facilities.

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mommy2boysaz has 10 years experience and specializes in OB.

288 Posts; 9,384 Profile Views

Sounds like your facility is much larger than ours, LibraSun. :)

We have no one in house 24/7. (450-500 births/year, 9 bed LDRP) We have a policy in place for twin deliveries that requires everyone be in house once patient is in active labor, and although there have been occasional grumbles (mostly from anesthesia), we do it. I am trying to bring VBAC back to our hospital with a similar policy, but it has not been received very well in the past. (Too expensive and too inconvenient.) Whereas, to me, it's about doing what's right for the woman (and not losing business to other area hospitals who are happy to offer them a VBAC, although it is usually a half-hearted offer...).

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LibraSunCNM has 10 years experience as a MSN and specializes in OB.

1,373 Posts; 25,646 Profile Views

We do about 1500 deliveries/year, which is small by NYC standards :-) I applaud you for advocating for access to VBAC at your hospital, even though it sounds like a tough sell with your administration. As with many shifts in practice in OB, high demand from the patients is sometimes the only way change is made. I have been lucky to work only in hospitals with a strong rate of successful VBAC, which was largely due to patient populations with a strong desire for it (Orthodox Jewish and Mexican). Hopefully your hospital will take notice that they lose business to other places by denying VBACs.

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