The nurse is teaching a class on vaginal birth after cesarean (VBAC). Which participant statement indicates that additional information is needed?
1. "Because my hospital is so small and in a rural area, they will not let me attempt a VBAC."
2. "Since the scar on my belly goes down from my navel, I am not a candidate for a VBAC."
3. "The rate of complications from VBAC is lower than the rate of complications from a cesarean."
4. "My first baby was in a breech position, so this pregnancy I can try a VBAC if the baby is head-down."
2
Explanation:
1. A repeat cesarean must be able to be performed immediately to safely attempt a VBAC. Many small and rural hospitals do not have surgical and anesthesia staff available at night or on weekends and holidays, and therefore do not allow clients to have a VBAC.
2. Skin incision is not indicative of uterine incision. Only the uterine incision is a factor in deciding if VBAC is advisable. Classic vertical incisions on the uterus have a higher rate of rupture and should not be attempted.
3. The incidence of uterine rupture is 0.5% to 0.9%. Women who have a successful VBAC have lower incidences of infection, less blood loss, fewer blood transfusions, and shorter hospital stays.
4. Nonrepeating conditions such as any nonvertex presentation might make VBAC a viable option as long as this pregnancy is vertex.
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