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Informed consent for attempted VBAC.(GUEST EDITORIAL)
There are certain topics that we just can't discuss enough, and attempted vaginal birth after a previous cesarean section is one of those. VBAC and informed consent for VBAC seem to be the topics du jour in every obstetrics program.
The number of VBACs seems to have declined following concerns about the risk for uterine rupture. Some physicians prefer elective C-sections to VBAC because of large monetary awards in medical malpractice lawsuits dealing with VBAC, such as a $30 million judgment in Philadelphia.
Is there life after this death for VBAC? As your friendly defense lawyer, I can tell you those are hard cases to defend.
A recent prospective, multicenter study that provides the first solid data on the risks of VBAC showed that only (0.7%) of 17,898 women who attempted VBAC for a term singleton developed uterine rupture. Only 12 term infants in the VBAC group developed hypoxic-is-chemic encephalopathy, 7 of them in the uterine-rupture subgroup. The absolute risk for hypoxic ischemic encephalopathy was approximately 1 case per 2,000 women attempting VBAC at term (N. Engl. J. Med. 2004;351:2647-9).
Even though the risks of a bad outcome are small--and ongoing statistics support that--those statistics take flight when you're in the witness chair and a catastrophically affected infant is with a parent in another witness chair.
You'll notice that when speakers at meetings present statistics about the risks or benefits of VBAC, there are no photographs of a catastrophically affected infant. But the jurors will see that. When a case goes to trial, the focus is on the care and treatment provided by a specific physician for a specific patient ...
- Medical malpractice insurers address VBAC risks.(Women's Health)(vaginal birth...
- Magazine article from: Family Practice News Schneider, Mary Ellen February 15, 2005 700+ words
...to as part of their policy. VBAC is subject to special guidelines...Physicians are covered to perform VBAC only if they follow certain...patient's labor, and providing informed consent to the patient. In addition, VBAC for twin gestations is prohibited...
- Insurers set criteria for VBAC coverage.(News)
- Magazine article from: OB GYN News Schneider, Mary Ellen February 1, 2005 700+ words
...to as part of their policy. VBAC is subject to special guidelines...Physicians are covered to perform VBAC only if they follow certain...patient's labor, and providing informed consent to the patient. In addition, VBAC for twin gestations is prohibited...
- Time to Reappraise VBAC.(Brief Article)(Statistical Data Included)
- Magazine article from: Family Practice News DRUZIN, MAURICE L. March 15, 2000 700+ words
...successful vaginal deliveries. VBAC is less likely to be successful...up to 60% of candidates for VBAC will successfully obtain a...the patient to complete the informed consent process. As a result of a...patients were forced to attempt VBAC, many centers now require...
- Fetal Heart Rate Can Signal Rupture Risk in VBAC.(Brief Article)
- Magazine article from: Family Practice News BATES, BETSY February 15, 2001 700+ words
...it may become evident that VBAC is not the best alternative...institution, he said. "Is VBAC safe [in community hospitals...Fetal monitoring. * Written informed consent indicating that the patient understands the risks inherent in VBAC. No community hospital should...
- Improved Selection of VBAC Patients Advised.
- Magazine article from: Family Practice News DEMOTT, KATHRYN December 15, 2000 700+ words
...appears to be a spate of sobering studies on VBAC risks, Dr. Hibbard and her associates...records of the 1,324 patients who attempted VBAC at the university hospital between 1989...the hospital's potential candidates for VBAC. The investigators also examined records...
- A VBAC PRIMER: TECHNICAL ISSUES FOR MIDWIVES.
- Magazine article from: Midwifery Today Rinehart, Heidi March 22, 2001 700+ words
...focusing on the powerful experience of VBAC--the courage, faith, joy, and triumph...subsequent dangerous surgeries. In Europe VBAC was the norm throughout the last century, while in the United States VBAC was almost unheard of until the 1950s...
- VBAC attempts, failures linked to maternal age.(Obstetrics)
- Magazine article from: OB GYN News MacNeil, Jane Salodof May 1, 2005 700+ words
...option of vaginal birth after cesarean (VBAC) delivery at 17 community and university...While 13,706 women (55%) attempted VBAC, 11,299 (45%) had an elective repeat...found as women got older, they attempted [VBAC] much less frequently than other women...
- Book Excerpt: The VBAC Companion: The Expectant Mother's Guide to Vaginal Birth...
- Newspaper article from: Special Delivery Korte, Diana December 22, 1998 700+ words
How to Manage Your VBAC Fears Not all women who have had cesareans have VBAC fears when they're pregnant again, but many do. Maybe that describes you. Once you recognize your own VBAC worries, you'll need some strategies to help you...
- GUEST EDITORIAL Try '1% Rule' With VBAC Labor.(Brief Article)(Editorial)
- Magazine article from: Family Practice News ELLIOTT, JOHN P. May 1, 2001 700+ words
...40% of labors, and that probably goes for VBAC labors as well. One of the criteria for attempting VBAC, according to the American College of Obstetricians...Gynecologists' 1999 practice bulletin on VBAC, is that a physician who is capable of monitoring...
- VBAC risk results in strict criteria or total ban.(Vaginal birth after cesarean...
- Newspaper article from: Healthcare Risk Management March 1, 2006 700+ words
VBAC risk results in strict criteria or total ban Vaginal birth after cesarean (VBAC) was tied to a number of obstetrics claims in the...several smaller hospitals, and some were performing VBAC before they were ready, she says. VBAC is somewhat...
Source: HighBeam Research, Informed consent for attempted VBAC.(GUEST EDITORIAL)