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Re: VBAC, immediate availabilty and change in hospital policyFrom: ainsron@msn.comMon Feb 12 18:08:14 2001
Our circumstances are very similar Kelly, I think we have to do the best with the cards we are playing with, as you must know, living at beautiful Lake Tahoe. I've been using a patient consent form for counselling all patients who have had a previous cesarean section, for a number of years. After the ACOG position came out, I added item #7. Brings up lots of questions, which hopefully I answer satisfactorily, but patients still sign it and still request VBAC. I give it to them at the time of their NOB visit with a brief explanation, and tell them that we will discuss any questions next visit, after they have had a chance to discuss it with family, etc. 1. I understand that I have had one or more prior cesarean(s). 2. I understand that I have the right to choose an elective repeat cesarean or to attempt a vaginal birth after a cesarean (VBAC). I also have the right to request a cesarean section during a trial of labor. 3. I understand that approximately 70% of women who undergo a VBAC will successfully deliver vaginally. 4. I understand that VBAC carries a lower risk to me than a cesarean delivery. The benefits of a successful VBAC include decreased blood loss, decreased post delivery complications and a shorter recuperative period. 5. I understand that the risk of a uterine rupture during VBAC in someone who has had a prior incision the non-contracting part of the uterus is at least 1%, possibly as high as 8%. 6. I understand that VBAC is associated with a higher risk of harm to my baby than to me. 7. If my uterus ruptures during my VBAC, I understand there may not be sufficient time to operate and prevent death or permanent brain injury to my baby. Recent guidelines of ACOG recommend that VBAC be restricted to hospitals that have the capability of immediate cesarean section at all times. This would limit VBAC to a small number of large hospitals, which we do not have in this area. 8. The exact frequency of death or permanent neurologic injury to the baby when the uterus ruptures is uncertain, but has been reported to be as high as 50%. 9. The risks to me after rupture of the uterus include but are not limited to hysterectomy (loss of the uterus), blood transfusion, infection, injury to internal organs (bowel, bladder, ureter), blood coagulation problems or death. 10. Probable contraindications to VBAC include previous classical uterine incision, multiple gestations and breech. 11. I assume the added risks associated with a trial of labor for my baby and myself. 12. I understand that during my VBAC, the use of oxytocin (Pitocin), a hormone, to make my uterus contract, may be necessary to assist me in my vaginal delivery. 13. There may be increased risk with the use of oxytocin or prostaglandins (Cytotec, Prostin, prostaglandin gel, etc.) during VBAC, and they will not be used for induction of labor. 14. I understand that if I choose a VBAC and end up needing a cesarean during labor, I may be at greater risk of certain problems (such as infection, bleeding,) than if I had an elective scheduled repeat cesarean. 15. I have read or have had read to me the above information and I understand it. I have had all my questions answered and I have received all the information I need to make an informed choice, after discussing my options with Dr. Ainsworth. I want to attempt a VBAC (Patient's Signature) OR I do not want to attempt a VBAC (Patient's Signature) Ronald E. Ainsworth, MD: (Signature)
-- Ronald E. Ainsworth, MD
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