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INFORMATION AND CONSENT FOR CLIENTS WITH PRIOR CESAREAN SECTION(S)

Taken in part from the document named above:

The ACOG (American College of Obstetricians & Gynecologists) guidelines regarding VBAC state that: The concept of routine repeat cesarean section should be replaced by a specific decision process between the patient and the physician. (In this case, client and midwife.) This form provides information about the option of attempting a vaginal birth after cesarean (VBAC) versus undergoing an elective repeat cesarean section. Pregnant women who previously have had a cesarean may choose to attempt a VBAC after discussion with their midwife. Please read the following information carefully, discuss your concerns with your midwife.

In deciding to have a VBAC at home I have been informed of the following:

 I understand that the benefits include:

·          elimination of operative and post-operative complications with successful VBAC

·          reduction in the length of postpartum recovery

·          easier infant care and bonding

·          birth in familiar surroundings of my own home with the involvement and support of a midwife

I understand that the risks include:

·          uterine rupture. I understand that this is a rare occurrence that can become catastrophic in a matter of minutes. I understand that although it occurs in less than 1% of appropriately attempted VBACs, when it does occur it can lead to excessive blood loss, damage to or even death of the infant and/or damage to or death of the mother. I also understand that these risks are further minimized by not using drugs to induce or stimulate labor, in particular, cytotec and pitocin.

I understand also that elective repeat cesareans also have risks. Cesarean section is a major abdominal operation and in some cases there can be injuries to the mother’s bladder or bowel, post-operative infections, or excessive bleeding which may require blood transfusions. In rare cases, fetal injury or trauma can occur.

Other alternatives to an elective cesarean section have been explained to me including: attendance of VBAC within the hospital setting (labor support) where there may be more immediate access to surgical intervention, should significant rupture occur during labor, and where more intensive care facilities such as blood transfusions and emergency neonatal personnel are readily available. I understand that in the event of a uterine rupture, prompt recognition and emergency management in a hospital can usually minimize serious results.

I understand that current medical standard of care and current State of Texas Midwifery Practice Standards and Principles recommends that VBACs occur in a hospital setting. I also understand that there are very few doctors who will allow a VBAC.  I understand that in having a home birth I can and will transfer care to a hospital if any of the following occur:

·          undue uterine pain

·          unusual bleeding

·          unusual fetal heart rate

·          deterioration of maternal vital signs

·          mother’s request