VBAC

Question 1

Indications for VBAC

Question 2

Contraindications for VBAC

Answer 2

• placenta praevia
• morbid adherance
• previous classical scar, uterine rupture
• three or more caesarians

Question 3

Risks of VBAC

Answer 3

• uterine rupture

Question 4

Identify the true risk for uterine rupture for VBAC

Answer 4

0.1-1.9%

Question 5

Complications resulting from repeat ceasers

Answer 5

• fetal respiratory distress
• increased likelihood of placenta praaevia and morbidly adhered placenta

Question 6

Midwife role in supporting women who have had a previous caesarian

Answer 6

• debrief about their previous cesarians
• develop plan discussing risks and benefits
• discuss a plan for each birth outcome
• routine antenatal care

Question 7

Describe the intrapartum consideration caring for women with VBAC

Answer 7

• IV access, group and hold
• continuous CTG
• inform anaesthetics, cheater, obs, paden
• 1:1 care continuously
• escalation for lack of progress
• active management in 3rd stage
• routine asessment of scar

UTERINE RUPTURE S+S
- prolonged, profound d bradycardia
- abnormal FGR
- acute abdominal pain and scar tenderness
- pain between contractions
- referred pain
- cessation of uterine activity
- vaginal bleeding
- maternal tachycardia

Postpartum
- debrief

Question 8

Risks vs benefits

Answer 8

VBAC
- satisfaction
- more successful breastfeeding rates

Elective
- reduce risk of uterine rupture
- avoid emergency C?S
– avoid pelvic floor trauma