Those of you who read the comments are probably aware of the obstetrician who calls himself “Ob” and believes that VBAC should be the norm, thinks midwives are great and, after all those years attending births, still seems pretty soft on the whole process of baby people emerging from other people. He leaves comments like this:
Reading this blog has not changed my practice, c/section rate, or had any impact on my labor management (or lack thereof) but it has damn sure changed the way I talk with my patients. I now make as sure as possible that my patient fully understands the reasons for her labor progress/c/section indication/induction/whatever. I thought I did before. Now I believe I do better. Is this supposed to be a self help blog?
Ob is looking for helpful feedback on the malpractice carrier mandated VBAC permit that all patients with a previous cesarean must read and sign. Nothing can be deleted, but text can be added.
What would your thoughts and feelings be as a patient (or birth attendant) when reading this form? What specific additions would you make?
Consent for Vaginal Birth After Cesarean Section
Name of Patient: _________________________ Chart # ________________
_____ 1. I understand that I have had one or more previous cesarean section(s).
_____ 2. I understand that I have the option of undergoing an elective repeat cesarean section 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 if there is a complication of labor.
_____ 6. I understand that VBAC carries a lower risk to me than does a cesarean delivery if there is no complication of labor.
_____ 7. 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.
_____ 8. 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. A Pitocin induction is contraindicated in previous VBACs and this drug will not be used in this manner.
_____ 9. 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.
_____ 10. I understand that if I choose a VBAC and end up having a cesarean during labor, I have a greater risk of problems than if I had had an elective repeat cesarean.
_____ 11. 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 or myself.
_____12. I understand that if my uterus ruptures during my VBAC, a hysterectomy (removal of the uterus) may become necessary.
_____ 13. I understand that [“Ob”] cannot guarantee that other physicians who may be covering for him will allow me to attempt a VBAC.
_____ 14. I understand the complications of VBAC may include but are not limited to uterine rupture and may also include any complication of a non-VBAC vaginal delivery.
I understand the above information. I have been given an opportunity to ask questions and have had them answered to my satisfaction.
_____ I want to attempt a VBAC. _____ I want a repeat cesarean.
[Patient and physician signatures]