The VBAC Consent

November 22, 2020

The American College of Obstetricians and Gynecologists (ACOG) issued a statement in 2004 supporting a woman's right to choose VBAC.

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Yet, they stated that in order to do so, you must have a physician available to provide emergency care immediately. Hospitals began to interpret this as meaning that there must be a surgical team constantly present. As this is a huge cost, especially for smaller community Hospitals, many stopped doing them and even went so far as to ban them. 

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The American Academy of Family Physicians (AAFP) then went on to review the information in 2005. They recommended, "TOLAC should not be restricted to facilities with available surgical teams present throughout labor since there is no evidence that these additional resources result in improved outcomes" They were not endorsing VBACS at home or out of hospital, but they did say the need for a constant surgical team did not improve outcomes.

However, many providers and facilities continue to resist VBACS. Because of the negative outlook by many providers, the presentation of the VBAC consent can be daunting and scary for parents to read.

I want you to remember that when presented with the consent, consider the cesarean consent as well. 

A VBAC consent can be very frightening for you to read and to sign. But I want to remind you that if you are a candidate, VBACs are highly successful and uterine ruptures are extremely rare.

What's Included in The VBAC Consent

Section 1: The Purpose of the Consent: 

Inside this section if the intent of the consent. The entire purpose of the VBAC consent is to provide you with the information needed to make an informed decision. An informed decision means that you have been presented with all the information needed to make a educated decision.

Medical informed consent is essential to the physician's ability to diagnose and treat patients as well as the patient's right to accept or reject clinical evaluation, treatment, or both. Medical informed consent should be an exchange of ideas that buttresses the patient-physician relationship. The consent process should be the foundation of the fiduciary relationship between a patient and a physician. Physicians must recognize that informed medical choice is an educational process and has the potential to affect the patient-physician alliance to their mutual benefit. Physicians must give patients equality in the covenant by educating them to make informed choices. When physicians and patients take medical informed consent seriously, the patient-physician relationship becomes a true partnership with shared decision-making authority and responsibility for outcomes. Physicians need to understand informed medical consent from an ethical foundation, as codified by statutory law in many states, and from a generalized common-law perspective requiring medical practice consistent with the standard of care. It is fundamental to the patient-physician relationship that each partner understands and accepts the degree of autonomy the patient desires in the decision-making process.

MayoClinicproceedings.org

The VBAC Risks

  • Same Risks as All other Vaginal Mamas: VBACS carry the same risks as all vaginal deliveries. This includes vaginal tearing, pelvic floor damage, and possible temporary incontinence.
  • PP Hemorrhage: This risk is low compared to the risk of PP hemorrhage after a cesarean.
  • Uterine Rupture: This is the doozy that scares most mamas and most doctors use to refuse a VBAC to a mama. This risk is less than 1% and 1 out of 5001 deliveries. It is only slightly higher than the risk to all moms (1 out of 1146 deliveries). Did you know that you have 1 out of 199 chances of falling to your death...hmmm. Puts that into perspective doesn't it?

The VBAC Benefits

  1. Much Easier recovery from vaginal delivery vs repeat cesarean.
  2. Lower risk of infection.
  3. Less blood loss (500ml compared to 1000 ml from c/s).
  4. VBAC allows you to have more babies. 
  5. You feel accomplished.
  6. A VBAC generally has fewer complications than a c-section.
  7. A VBAC allows you to be more involved with the birth process.
  8. Avoiding a major surgery!!
  9. VBACS have a lower rate of maternal death
  10. It is a more natural way to birth.
  11. The VBAC recovery is less complicated and much smoother.
  12. A VBAC allows a shorter hospital stay than from a surgery.
  13. You avoid the risk of future adhesions caused by cut or nicked bladder, bowel, and uterus.
  14. Babies delivered vaginally receive the natural microbiome exposure.
  15. You decrease your chances of hysterectomy.
  16. Less chance of a blood transfusion.
  17. Breastfeeding may be established sooner.
  18. Attachment to baby happens immediately.

Repeat Cesarean Risks

As with all surgeries, a cesarean carries risks, however, a repeat cesarean carries the normal surgery risks but also extra risks.

  1. Placental issues in future pregnancies. Such as placenta acreta. Placenta accreta occurs when the placenta grows too deeply into the uterine wall and causes severe blood loss. Placenta previa happens more often in women with multiple previous cesarean sections. If placenta previa is present, the risk of placenta accreta, increases with each previous cesarean birth. This increases your risk for major bleeding and a hysterectomy.
  2. Incisional infections are also a risk of a repeat cesarean section, and some times a failure to heal at all. Each cesarean carries a risk of increased drainage.
  3. Repeat cesareans limit the amount of children you can have in the future.
  4. Recovery after major abd sx is brutal, plus caring for a newborn.
  5. Increases loss of blood from surgery is 1000ml compared to average vaginal delivery which is 500 ml.
  6. Risk of damage to surrounding organs during the surgery.

Repeat Cesarean Benefits

  • You are able to schedule your delivery and know the baby's birthday ahead of time.
  • You might not know what to expect from a VBAC but you already know what to expect from a cesarean.
  • No damage to your pelvic floor.

Acknowledgments of Informed Consent

This section is where you acknowledge that you have read the form, have been informed of the options, risks, and benefits.

Your Choice

In this section you choose whether you want a consent to a TOLAC (trial of labor after cesarean) and the option to VBAC or a repeat cesarean section.

Signature

You and your provider will sign this section.

Examples of VBAC Consents

VBAC Consent One

VBAC Consent Two

VBAC Consent Three

VBAC Consent Four (This is my favorite)

Mama the VBAC consent can be scary when it is presented to you and your partner. I want you to understand that there are risks but there are also benefits. Education is key and knowledge is power. Educate yourself so that you can choose the best route for YOU!

Don't forget to sign up for the free VBAC MINI COURSE NOW!

This group, board, and guidance have been absolutely invaluable.

I was extremely comfortable asking questions, making decisions and even though nothing went according to my "plan", I couldn't be any happier with the way everything went!!!
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- Stacy A.
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