The nurse is teaching a class on vaginal birth after cesarean (VBAC). Which statement by a participant indicates that additional information is needed?

Question

1. "Since the scar on my belly goes down from my navel, I am not a candidate for a VBAC."
2. "My first baby was in a breech position, so this pregnancy I can try a VBAC if the baby is head-down."
3. "Because my hospital is so small and in a rural area, they won't let me attempt a VBAC."
4. "The rate of complications from VBAC is lower than the rate of complications from a cesarean."

Answer 1

Correct Answer: 1
Rationale 1: Skin incision is not indicative of uterine incision. Only the uterine incision is a factor in deciding if VBAC is advisable. Classical vertical incisions on the uterus have a higher rate of rupture and should not be attempted.
Rationale 2: Non-repeating conditions such as any non-vertex presentation might make VBAC a viable option as long as this pregnancy is vertex.
Rationale 3: 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, and on weekends and holidays, and therefore do not allow patients to have a VBAC.
Rationale 4: The incidence of uterine rupture is 0.9%. Women who have a successful VBAC have lower incidences of infection, less blood loss, fewer blood transfusions, and shorter hospital stays.