Re: VBAC consent form
From: Susan Mcniel (smcniel@u.washington.edu)
Fri Jun 27 18:46:42 1997
Thank you! I am interested in the spanish version.
Susan McNiel, MN, ARNP
On Fri, 27 Jun 1997, Geffrey H. Klein, MD wrote:
> >Where can I obtain a copy of Dr. Jeffrey Phalen's VBAC consent form?
> >Susan McNiel, MN, ARNP
>
> Here you go... I had it translated into spanish if you are interested..
>
> _________
>
> 1. I understand that I have had one or more prior cesarean[s].
>
> 2. I understand that I have the option of undergoing an elective repeat
> cesarean or
> attempting a vaginal birth after a cesarean [VBAC].
>
> 3. I understand that approximately 70% of women who undergo a VBAC will
> successfully deliver vaginally.
>
> 4. I understand that the risk of a uterine rupture during a VBAC in someone
> such as myself, who has had a prior incision in the noncontracting part of
> my uterus, is around 1%.
>
> 5. I understand that VBAC is associated with a higher risk of harm to my
> baby than to me.
>
> 6. I understand that if my uterus ruptures during my VBAC, there may not be
> sufficient
> time to operate and to prevent the death of or permanent brain injury
> to my baby.
>
> 7. I understand that the decision to have a VBAC is entirely my own, and
> the option of an
> elective repeat cesarean has been discussed with me.
>
> 8. I understand that VBAC carries a lower risk to me than does a cesarean
> delivery.
>
> 9. I understand that if I deliver vaginally, I most likely will have fewer
> problems after delivery
> and a shorter hospital stay than if I have a cesarean delivery.
>
> 10. I understand that during my VBAC, the use of oxytocin(Pitocin) hormone
> to make my
> uterus contract may be necessary to assist me in my vaginal delivery,
> and the risks of this
> drug have been thoroughly explained to me.
>
> 11. I understand that if I choose a VBAC and end up having a cesarean
> during labor, I have a
> greater risk of problems that if I had had an elective repeat
> cesarean.
>
> 12. I have read or have had read to the above information and I understand
> it.
>
> I have received all the information I want. After discussing the matter
> with my doctor,
>
> I want to attempt a VBAC. I want a repeat cesarean.
>
> ____________________ X____________________
> [PRINT PATIENT'S NAME] [PATIENT'S SIGNATURE]
> ____________________ X____________________
>
> Geffrey H. Klein, MD
> listowner: OB-GYN-L
> Advisory Board Chairman, OBGYN.net < http://www.obgyn.net >
> Co-moderator: sci.med.obgyn
> gklein@bcm.tmc.edu gklein@icsi.net
> http://members.aol.com/gklein01/geff.html
> 6800 W. Loop South #520
> Bellaire, Texas 77401
> (713) 664 8900
>
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