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Birth plans
Published in Sheila Broderick, Ruth Cochrane, Trauma and Birth, 2020
Sheila Broderick, Ruth Cochrane
Sometimes the birth plan will contain elements that the staff find a challenge, and then the discussion may take longer, or may take more than one meeting with the involvement of others. Staff are not being awkward when they find it a challenge – there will be challenging features in the birth plan that do not fit with their training or their Trust’s policies. Take, for example, a case of a woman who had a CS for her first delivery and who wishes to have her next baby normally at home. Her midwife will be able to talk about how a woman with a previous CS is usually looked after when she is in labour, and how that would necessarily alter if she was at home rather than in hospital. The midwife would tell her line manager or supervisor to make sure that the woman was fully informed about the relative risks of this choice, and the senior midwife or supervisor would bring the case to the attention of senior midwifery and obstetric staff. Being forewarned about a planned vaginal birth after Caesarean (VBAC) at home means that staff on call can be prepared, as much as is possible, should the woman require urgent transfer into a hospital.
The journey of homebirth after caesarean (HBAC)
Published in Hannah Dahlen, Bashi Kumar-Hazard, Virginia Schmied, Birthing Outside the System, 2020
VBAC is an important contemporary health issue as caesarean section rates increase globally. The Lancet series on optimising caesarean section use identified an international doubling of caesarean rates since the year 2000 with an estimated 29.7 million caesareans worldwide in 2015 (Boerma et al., 2018). Rising caesarean rates are linked with poorer outcomes for both mother and baby, are associated with higher risk of severe acute maternal morbidity and impact long-term health (Clark, 2011; Sandall et al., 2018; Korb et al., 2019). Caesarean sections are costly to health services (Fawsitt et al., 2013; Fobelets et al., 2018). Yet, repeat caesarean is the main reason women have a caesarean in Australia (AIHW, 2018). VBAC does come with some unique health issues, due to the previous caesarean. Very rarely, the site of the previous caesarean in the wall of the uterus can open partially or fully and lead to a uterine rupture and if not identified early can lead to maternal shock and haemorrhage and foetal death (Guiliano et al., 2014). The uterine rupture rate is around one in 200 women (Motomura et al., 2017). Hysterectomy and perinatal mortality rates related to uterine rupture are very low. A recent European study found rates of 2.2 and 3.2 per 10,000 during labour for a VBAC (Vandenberghe et al., 2019). Uterine rupture rates do increase with shorter interpregnancy rates and with the use of pharmacological induction methods, such as prostaglandin pessaries and synthetic oxytocin infusions (Stamilio, 2007; Dekker, 2010).
SBA Questions
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
A 30-year-old G3P2 attends the VBAC clinic for counselling about mode of delivery. This is an uncomplicated pregnancy and she had indicated after her mid-trimester scan that she would like to try for a vaginal delivery. She had an emergency CS for her first pregnancy because of fetal distress and then had a uterine rupture in the second pregnancy intrapartum. The outcome at surgery was a live birth. What is the risk of uterine rupture that you will quote for this woman if she went for VBAC?≥1:200 (0.5%)≥1:100 (1%)≥1:20 (5%)≥1:150 (0.67%)≥1:50 (2%)
Women’s experiences of birth and birth options counselling after laparoscopic or open myomectomy
Published in Journal of Obstetrics and Gynaecology, 2023
Thomas C. Grainger, Anna McDougall, Zwelihle Magama, Jeewantha Ranawakagedon, Rebecca Mallick, Funlayo Odejinmi
Post myomectomy the management of subsequent pregnancy and birth remains controversial. There is no consensus amongst specialists as to the optimum interval to pregnancy and mode of birth (Weibel et al.2014). The scarred uterus post myomectomy is often compared to the uterus after a single previous lower segment caesarean section (LSCS), provided there is no breach of the endometrial cavity. This is not reflected in the counselling given to women, however, with inconsistency between the guidelines used for birth options after caesarean section, and the advice given after myomectomy. Many women who have a previous LSCS opt for VBAC (vaginal birth after caesarean) with dedicated birth-options clinics widely available. There have been studies seeking the opinion of women on how they would prefer to give birth post caesarean (Attanasio, Kozhimannil and Kjerulff 2019); unfortunately, such studies do not exist for women after myomectomy. Post myomectomy many women are advised to undergo elective caesarean section (ELCS), despite additional complications that can arise from caesarean in this group (Gimovsky et al.2020). In the context of emerging evidence to support the safety of trial of labour after myomectomy (TOLAM) (Gambacorti-Passerini et al.2018) and the essential caveat of informed decision-making we felt that it was the opportune time to explore the perspectives of women who have given birth post myomectomy.
Factors associated with the outcome of TOLAC after one previous caesarean section: a retrospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Shaina Parveen, Sasirekha Rengaraj, Latha Chaturvedula
The probability of a successful vaginal delivery after a previous Caesarean Section should be discussed in the prenatal period itself. There are many factors that are maternal and obstetric and associated with the success and failure of VBAC. The success of TOLAC not only minimises the adverse maternal and perinatal outcome but also reduces the cost. Repeat emergency Caesarean Section (failed VBAC) is associated with increase in perinatal morbidity and maternal morbidities (e.g. surgical infections, thromboembolism, pelvic adhesions, morbidly adherent placenta, and bladder injury) than vaginal birth (successful VBAC) (Guise et al. 2004; Cheng et al. 2011; Abdelazim et al. 2014). It is essential to do a detailed analysis of these women and find out the factors associated with successful/failed TOLAC as they are the major contributor to overall Caesarean Section. Also, the presence or absence of these factors may help in counselling women about attempting VBAC. This is so that the success rate of VBAC can be increased.
Childbirth Is Not a Medical Emergency: Maternal Right to Informed Consent throughout Labor and Delivery
Published in Journal of Legal Medicine, 2018
Similarly, in Schreiber, the court found the treating obstetrician liable for disregarding the laboring mother’s stated delivery preference.113 In Schreiber, a pregnant woman desired a vaginal birth after cesarean delivery (hereinafter VBAC).114 A VBAC refers to a successful vaginal delivery in a woman with a history of one or more prior cesarean deliveries.115 After counseling by her physician, she consented to a trial of labor and was monitored by her physician during the labor process.116 The mother sued her physician, alleging that he failed to adequately inform her of the option of a cesarean delivery.117 The trial court denied her claim, finding that she had consented to the VBAC and never properly withdrew that consent, even though she requested a cesarean delivery several times during her labor course.118 The appellate court overturned the trial court’s holding, reasoning that a birthing woman retains decision-making capacity throughout her labor, including the right to decide between a cesarean or vaginal birth.119 Thus, to the same extent that she was competent to provide consent for a VBAC, she was competent to withdraw that consent—even after her labor had ensued. The court noted that a physician who “ignored his patient[’s change in consent] and substituted his own choice for hers” faces liability.120