Subject: Prenatal Care for Planned Vaginal Birth After Cesarean, VBAC

POLICY: VBAC Protocol for antepartum care

GUIDELINES: 1. All pregnant women will be questioned about variances in prior births including prior cesarean section deliveries. 

2. Women with one previous low transverse C/S delivery can be considered for VBAC with Women and Birth Care, Inc.

3. The operative report from the Cesarean delivery will be reviewed and must reveal a double layer closure to repair the uterus at the time of surgery.

3. Women who have previously had more than one cesarean section or had a previous classical or T-shaped incision (or unknown incision type) will not be considered for care with Women and Birth Care, Inc. and will be referred to an appropriate obstetric provider. Women who had the Cesarean at a gestation prior to 28 weeks will not be considered for VBAC with Women and Birth Care, Inc.

4. Women who have had previous extensive fundal uterine surgery or previous uterine rupture or if they have medical or obstetric complications that otherwise preclude a safe vaginal delivery including diagnosed macrosomia or clinically inadequate pelvis may not be considered for care with Women and Birth Care, Inc.

5. Women who have any of the following risk factors may not be considered for care with Women and Birth Care, Inc.

·        Uncontrolled gestational diabetes

·        Pregnancy induced hypertention

·        Gestation <37 weeks or > 41 weeks

6. Women planning a VBAC with Women and Birth Care, Inc. will complete an approved VBAC class prior to 37 weeks.

7. Women planning VBAC will have a delivery interval greater than or equal to 18 months, from the Cesarean delivery to the current estimated date of delivery.

PROCEDURE: 1.  All pregnant women will be questioned about variances in prior births including prior cesarean section deliveries at their consultation prior to their first OB visit.  The following exclusion criteria will be followed:

·        NO previous classical or T-shaped incisions (or unknown incision type with suspicion of other than low transverse)

·        NO previous extensive fundal uterine surgery or previous uterine rupture

·        NO more than one previous cesarean section

·        No medical or obstetric complications that would otherwise preclude a safe vaginal delivery

2. During the course of the prenatal care (prior to 37 weeks) the woman will be counselled about the potential benefits, risks and alternatives to VBAC.  She will receive the following links for further research:

·        Evidence based data from Childbirth Connection

·        Consensus Statement from NIH regarding VBAC

3. During the course of prenatal care the following will be assessed and if found the client will be referred out of Women and Birth Care, Inc. to higher level care for high risk pregnancy/birth:

·        Diagnosed macrosomia

·        Inadequate pelvis

·        Uncontrolled gestational diabetes

·        Pregnancy induced hypertension

·        Gestation <37 weeks or > 41 weeks at delivery

3. During the course of prenatal care an ultrasound must be performed in the second trimester to determine the location of the placenta within the uterus and the scarring location determined from prior care records of the cesarean birth.

4. The travel time to a level one hospital for emergency care must be less than 30 minutes.

5. The woman and her partner if applicable will attend an approved VBAC class prior to 37 weeks of pregnancy.