Which of the following clients could be a candidate for a vaginal birth after cesarean section (VBAC)?
a. A 32-year-old gravida 2, para 1, who had a primary cesarean section for fetal distress
b. A 23-year-old gravida 3, para 2, who had two cesarean sections with classic incisions
c. An 18-year-old gravida 3, para 2, who had cesarean section for labor dystocia during second stage with birth of newborns who weighed 8 pounds 10 ounces, and 9 pounds, respectively
d. A 25-year-old gravida 1, para 0, who wants to have a scheduled cesarean section rather than go through the process of labor because she is very fearful of the pain associated with childbirth
ANS: A
VBAC can be done if the need for the primary cesarean section was based on factors other than cephalopelvic disproportion (CPD) and macrosomia. A client who has had a prior classic incision into the uterus is not a candidate for this type of procedure. Based on the presented history of a cesarean section for labor dystocia during second stage with birth of newborns who weighed 8 pounds 10 ounces, and 9 pounds, respectively, this client is at risk for uterine rupture and for delivering another macrosomic infant because she has already had two cesarean sections for the same indications. A client who wants to have a scheduled cesarean section rather than go through the process of labor because she is very fearful of the pain associated with childbirth is not a candidate for a VBAC because she does not meet the clinical criteria.
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