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Re: VBAC dying art>From: Hugo D Ribot Jr (hribot@mindspring.com)Mon Mar 30 20:52:16 2009
This just came up in a conversation with a long time patient I saw today. Her daughter is also a former patient who lives 30 minutes away in the metro Atlanta area. The daughter had her first baby by C/S elsewhere due to (predictably enough) a failed induction due to non-reassuring tracing starting with a green cervix. The reason for induction was "low fluid". She stated there was nuchal and other cord entanglement at delivery. She feels strongly about attempting a VBAC with her next pregnancy. Trouble is, both mother and daughter have apparently researched this and they told me that only one doc in Atlanta other than me is doing VBACs. Actually stated that many hospitals (and OBs) they contacted flat out told them they will not do trials of labor, no matter if the patient is a great VBAC candidate with a non-recurring indication for the original C/S. I feel that as long as several guidelines are adhered to: - avoid induction of labor (other than AROM in someone with a huge Bishop score already contracting) - avoid usage of prostaglandin agents - limit use (and dosage) of oxytocin for augmentation to patients already in true labor with a soft, nearly fully effaced cervix at least 3-4 cms - avoid trial of labor with any prior vertical uterine incisions then VBACs are extremely safe and have a 80+% success rate. At least in my 19 year experience.
-- Hugo D. Ribot Jr., M.D., FACOG Cartersville, Georgia Private practice since 1990 2 MDs/3 CNMs/1 NP
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