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VBAC
Not a guaranteed 24-hour anesthesia immediately available for emergency c-section?
My 2nd baby is due 16 months after my first. I was surprised when my doctor asked if I want to have a VBAC - I just assumed that a repeat c-section would be insisted upon.
She gave me some literature to review and we are going to discuss at our next few visits.
I am reading through the "risks" and the hospital I am delivering at does not guarantee 24 hour anesthesia immediately available for a c-section.
Now, I am considering the VBAC, but will not do a med-free birth.
Thoughts? Is this pretty standard verbiage?
I will of course discuss with my doctor, but want your thoughts as well.
Thanks in advance for your thoughts and experiences!
This discussion has been closed.
Re: Not a guaranteed 24-hour anesthesia immediately available for emergency c-section?
I don't understand how a hospital can NOT guarantee anesthesia for a CS. It's major surgery. They must have an anesthesiologist on call at all times. I can understand not guaranteeing anesthesia for a vaginal delivery but it's not like they can cut you open without anesthetic.
Presumably if you go for VBAC and end up needing a CS it'd be an ECS which can happen even in the case of primigravid vaginal delivery.
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That was the same with my hospital. I went in for delivery and the anesthesiologist only worked until 12am. I declined the epi as I had planned a vaginal, med-free birth. Once they decided I needed an emerg c/s, I had a 20 minute wait before I could get my epidural while they called him back.
There was an anesthesiologist in the ER, but they won't use him in L&D unless it's life and death.
This is called BAIT AND SWITCH. He's leading you on saying its a possibility, when in reality is not due to ACOG position statement and liability insurance requiring on site 24/7 anesthesia at all times for anyone attempting a TOL (trial of labor).
If this hospital does not have what you need to attempt a VBAC, then you must look for a different hospital, and even maybe a different doctor (if the doctor doesn't have privileges at an adequate hospital) to get your VBAC.
I may be wrong about this, but I don't think nurses or OBs are supposed to redose epidurals. So if she needed more medication in her epi for the cesarean, they would still have to wait for the anesthesiologist. I remember when I had an epi during my first labor, and also when I worked in L&D, the nurses had to call anesthesia anytime an epidural needed adjusting or ran out of meds. And often that meant people had to wait.
I suppose it is no different than if you are at home or at a birth center and have to transfer for a cesarean. But the hospital should be clear about their limitations and the fact that they are probably not able to handle an emergency as rapidly as a hospital with 24 hour anesthesia can. But ITA that it is absurd for a hospital like that two say they can handle other labors but not handle VBACs. It really comes down to liability, not safety.
ITA. But I am sure this hospital is only warning the VBAC people that they don't have 24 hour anesthesia. All of the other women there are probably under the false assumption that they are delivering in a hospital therefore they have immediate access to those things. Definitely a liability thing. I was planning a birth center birth for my first (before I was transferred for the c/s). I had to sign no less than three forms during that time stating that I understood that I was not going to have those types of things (epi, etc) available to me if I delivered there. The hospital who doesn't have that immediately available should likewise be informing patients.
I have the same issue with where I live. The closest hospital with a 24 hour anesthesiologist is 1 1/2 hours away. The way it was explained to me is it is not so much about having to perform an emergency c-section (I'm sure they have a plan of action in place) if labor is not progressing or if baby's heart rate drops, but it is more about if you have a uterine rupture while attempting a VBAC. A placenta rupture is usually associated with a uterine rupture and if that is the case they have 8-10 minutes to get the baby out.
Most of these hospitals have an anesthesiologist on call but it may take up to 30 minutes for them to get there. It is one of the downfalls of delivering in a rural hospital. My OB has explained to me that all of the stars will have to be aligned for me to have a successful VBAC. Basically I would have to go in to labor naturally when all the proper medical personnel are present.
Thanks for this feedback! I have an appointment with my OB tomorrow and am going to bring all this up.
I appreciate you sharing with me.
ACOG relaxed their recommendations regarding VABC about 2 years and issued a new statement:
Finally, the statement also provides the following recommendations that are based mainly on consensus and expert opinion (level C):
https://www.medscape.com/viewarticle/725597
If a hospital isn't safe to VBAC in, it's not safe to birth in. Period. There are plenty of other obstetrical emergencies that the hospital needs to handle - cord prolapse, sudden and acute fetal distress, women with placenta previa who go into labor, women presenting with an ruptured ectopic pregnancy. These are serious conditions that require immediate medical attention. Somehow hospitals manage to deal with them.
Hospitals also have to deal with all kinds of other emergencies that require anesthesiologists - car accidents, ruptured appendixes, etc,.
If you know you want an epidural, they will probably just call the anesthesiologist in. That has nothing to do with VBAC in general - I'm sure they have to get called in all the time for that. And if the anesthesiologist is on call, he can sleep in the hospital while you are there just in case. I'm sure it's silly to have him there while no one is laboring (and believe me - L&D floors in small hospitals are often DEAD with nothing going on). But if there is a patient who has a notable risk factor, there is no reason why he can't sleep there if he is on call. And I am SURE they have on-call anesthesiologists for women wanting epidurals!!
ETA: I know this sounds barbaric but it IS possible for the OB to shoot you up with a lot of local anesthetic to get the baby out in an extreme emergency. Having an epidural in place should help. I know that sounds awful and I am NOT suggesting that's a good option. I'm simply saying that it has been done in extreme emergencies.