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Since we talked about consent form for home VBAC several weeks ago, I decided
to go ahead and write one for my practice. This is my working draft so
far - comments are welcome, as is copying for your own use, if you wish.
Consent for Vaginal Birth After Cesarean Section At Home
1. I have had one or more previous cesarean sections (C/S), have records
documenting a lower uterine segment incision, and desire a vaginal birth
after C/S at home with my current pregnancy.
2. I have been informed of the following most recent (1994) guidelines
from the American College of Obstetricians and Gynecologists (ACOG), which
state that:
The concept of routine repeat cesarean birth should be replaced by a specific
decision process between the patient and the physician for a subsequent
mode of delivery;
In the absence of contraindication, a woman with one previous cesarean
delivery with a lower segment incision should be counseled and encouraged
to undergo a trial of labor in her current pregnancy;
A woman who has had two or more previous cesarean deliveries with lower
uterine segment incisions and who wishes to attempt vaginal birth should
not be discouraged from doing so in the absence of contraindications;
A trial of labor and delivery should occur in a hospital setting that has
professional resources to respond to acute intrapartum obstetrical emergencies.
3. My midwife has informed me regarding:
A) The relative risks of VBAC:
Complete rupture of the uterus: occurs in less than 1% of women having
a VBAC; can lead to severe internal hemorrhage of the mother and death
of the baby; this risk does not appear to be greater for women with a previous
uterine incision than for women who have a normal uterus;
Incomplete rupture of the uterus: occurs about 1% of the time; no symptoms
and usually does not require any additional care;
B) The relative benefits of VBAC:
Prevention of death and potential complications of surgery (blood loss,
infection, injury to bowel urinary tract, etc., blood clots in the legs),
a Public Citizen Report places maternal death rate at 18.4 per 100,000
women with elective C/S and less than half that for a vaginal birth;
Faster recovery time after birth
Easier time with breastfeeding without abdominal incision
Less than half the cost of a C/S
Decreased death and injury in baby resulting from surgical delivery
Resultant positive emotional state from successful vaginal birth
I understand that, in the case of a complete uterine rupture, adverse consequences
can be catastrophic in a matter of minutes. By choosing to have a VBAC
outside of the hospital setting, I realize that I may not be diagnosed
as quickly as having a potential rupture and that I may not receive emergency
treatment and/or surgery as quickly as I would if I were having my baby
inside of the hospital. It is possible that loss of time in transfer could
be harmful or even fatal to myself and/or my baby.
4. After considering the above information, I believe that the benefits
of VBAC at home outweigh the risks in my situation, and I choose to seek
care with [midwife], [credentials], of [Business Name] and pursue a VBAC
at home rather than in the hospital.
_____________________________________ ______________________________________
Client Signature/ Date Partner Signature/ Date
_____________________________________
