A patient is consulting a certified nurse-midwife because she is hoping for a vaginal birth after cesarean (VBAC) with this pregnancy. Which statement indicates that the patient requires more information about VBAC?
1. "I can try a vaginal birth because my uterine incision is a low segment transverse incision."
2. "The vertical scar on my skin doesn't mean that the scar on my uterus goes in the same direction."
3. "There is about a 90% chance of giving birth vaginally after a cesarean."
4. "Because my hospital has a surgery staff on call 24 hours a day, I can try a VBAC there."
3
Rationale 1: Only low segment transverse uterine incisions are recommended for attempting a VBAC.
Rationale 2: Abdominal skin incisions and uterine incisions are not always the same.
Rationale 3: The highest success rates for VBAC are 60% to 80%, and occur among women whose previous cesarean was performed because of nonrecurring indications.
Rationale 4: VBAC should be attempted only in facilities that have 24-hour coverage of operating room staff and anesthesia.
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