Vaginal+Birth+After+Ceserean

**Vaginal Birth After Ceserean**

CCRMC Perinatal Unit is committed to offering safe VTOL as an option for women with a prior cesarean delivery. We have instituted standardized physician screening, nursing orders, pitocin restrictions, and an OB response team dedicated to rapid delivery in the event of a possible uterine rupture. We also, of course, offer elective cesarean repeat cesarean to all women with a prior cesarean delivery.

VTOL is currently not offered as an option if she has a prior incision in contractile part of the uterus (some myomectomies, rare cesareans with vertical incisions in the uterus usually for very preterm breech or very large back down transverse lie), she requires induction with an unfavorable cervix AND has had no prior vaginal delivery, prior cesarean was less than 6 months from conception of this pregnancy, or prior cesarean was at less than 32 weeks without an operative report verifying incision.

Prior vertical SKIN incision is permissible for VTOL if the history of cesarean is consistent with low transverse incision.

We also do not recommend a VTOL if we think that she will have a lower success rate (fetal macrosomia, etc) or she is not at least somewhat committed to going through labor.

There is a new [|VBAC checklist] (pdf updated 6/09) to help counsel women and be alert to the risks of a vaginal birth after cesearan (VBAC). When considering whether your patient can attempt a vaginal trial of labor (VTOL) please review the checklist in clinic. In addition:
 * 1) Attempt to obtain the operative report from the prior C-section to confirm a term lower uterine transverse scar.
 * 2) Discuss with the patient the indication for prior ceserean section and consider reversible risks (Breech, Fetal Heart Rate Abnormalities, etc)
 * 3) Inform the patient that a VTOL is not recommended with a unfavorable cervix, and this can only be determined at time of induction.
 * 4) Consult with OB if you are unsure of the patient's ability to attempt a VTOL.

Planning a VBAC in West County (Alta Bates)

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