“Ob” printed out all of your suggestions for revisions to his malpractice carrier mandated VBAC permit that his malpractice carrier requires and took them into consideration.
His caveats and responses to a few suggestions:
- He has separate forms for elective and elective repeat cesareans and cannot combine them or give them side-by-side. He consults first when he and the patient get to the forms.
- Patients always have the right to vacillate.
- The elective repeat cesarean form is worded in favor of VBAC.
- He has to give nonspecific numbers for legal purposes, noting that “somewhere someone has a different number and it can be used against one,” so it’s either nonspecific or no option.
- He performs scar checks (revisit or revision) gently after delivery (in all his years has only found one silent separation but she hemorrhaged and required a mini laparotomy repair.)
- Epidurals do not seem to mask dehiscence pain. They are not contraindicated.
- There is no such thing as impending rupture. It has or it hasn’t.
- He cannot put incorrect info in here and must consult with all patients at their first visit, which is when this is given to the patient. She MUST take it home to read and bring it back at the second visit.
Please read the previous version and kindly share your thoughts if you have a moment.
Consent for Vaginal Birth After Cesarean Section (VBAC)
Name of Patient: ________________________ Chart # _____________
Please initial each line:
_____ 1. I understand that I have had one or more previous cesarean section(s). My records have been reviewed from my delivery (ies) and per recommendations of the American College of Obstetrics and Gynecology I am being offered a trial of labor.
_____ 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 choose a VBAC will successfully deliver vaginally.
_____ 4. 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.
_____ 5. I understand that VBAC carries a lower risk to me than does a cesarean delivery if there is no complication of labor.
_____ 6. 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.
_____ 7. I understand that during a VBAC the use of oxytocin (Pitocin) hormone that can assist with uterine contractions is relatively contraindicated. If it appears this medication is indicated we will discuss its usage and options before deciding to proceed. A Pitocin induction is contraindicated in VBAC’s and this drug will not be used in this manner.
_____ 8. 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 along with the option of a repeat cesarean section and the risks and benefits of each.
_____ 9. I understand that if I choose a VBAC and after laboring require a repeat cesarean, I have a greater risk of infection than if I had had an elective repeat cesarean however there is a theoretical decrease risk for transient breathing difficulty to your newborn.
_____ 10. I understand that the risk of a uterine rupture (acute separation of the uterine wall where the previous cesarean delivery was performed) during a VBAC in someone such as myself, whose prior incision was in the noncontracting part of my uterus (a low transverse incision), is around 1%. Most uterine ruptures are not catastrophic (resulting is fetal or maternal harm) but this is unpredictable.
_____ 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 but this is an uncommon event.
_____ 12. I understand that if my uterus ruptures during my VBAC, a hysterectomy (removal of the uterus) may become necessary at a higher rate than with a scheduled cesarean or a vaginal delivery.
_____ 13. I understand that [“Ob”] cannot guarantee that other physicians who may be covering for him will allow me to attempt a VBAC (while one cannot be forced to undergo a repeat cesarean delivery you are placing yourself at odds with what I require of you to be able to offer this option of delivery. I cover for myself most of the time but I must have the support of other physicians to maintain my practice. As labor is unpredictable I cannot guarantee that I will be available at all times.)
______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 desire to attempt a VBAC. ______ I desire a repeat cesarean section.
Patient’s signature Date