Hospital policy VBAC

[victoriascrumptious]

Why does my local hospital have a policy of not "allowing" VBAC women to go past 38 weeks? I know they can't force anyone into anything-but why the 38 week thing.

that seems really counter productive, as the majority of women will deliver around 41 weeks.

also, i presume that means they induce / section again at 38 weeks. respiratory morbidity is greatly increased for sections under 39 weeks IIRC

also, it might be policy, but it is not the law! you can make an informed to decision to accept or decline a section/induction at 38 weekgs

your best chance of a succesful VBAC starts with a spontaneous labour

i am not sure why it would be a policy, i can't think of a good reason , sorry!

Your hospital's policy will be set by committee strongly influenced by the boss consultant(s) at the time this was done. They will have had their reasons - whether those reasons make much sense in the light of current research and thinking will be another matter. If nobody actively challenges these policies (from with the hospital - obviously patients will do so all the time) they can stay in place for years. My local hospital (in which I've birthed and work) performs more GTTs on pregnant women than anywhere else known to the lab staff! Because it's 'policy' of course.

An induction at 38 weeks is a recipe for induction in most people. I would be inclined to point out that it's YOU having the baby not the policy - so could they please give you their arguement for not going beyond 38 weeks, listen politely and then say what you are going to do instead

Lulu, i'm not sure what the MW meant but it all seems a bit weird. A friend mentioned it might be due to increased pressue on the scar but that's the first time ive heard of that

Thanks Northen Lurker

What a strange policy -are you absolutely sure?

I was told at LWH that they wouldn't be keen to induce at all for VBAC, because the rapid kick start to labour may increase likelihood of scar dehiscence.

Or do you mean that they like to book in sections @ the 38 week mark to avoid the possibility of labour?

I'm not sure Mazzy, I guess I should have asked a few more questions

That sounds all wrong to me too. At my hospital even if you choose ELCS 2nd time round they normally do it at 39 weeks not 38, but as I wanted to go for VBAC my consultant is happy for me to go right up to 42 weeks if it came to that. And like Mazzy says, lots of places are reluctant to induce at all after a CS.

Maybe ask some more questions at your next appt to get more clarity on this? - but if they are still saying policy is 38 weeks then like the others said, you are still free to ignore it!

pressure on the scar is increased by labour, not by pregnancy per se AFAIK, also induction can increase the risk of rupture, not hugely , but it can do. the safest way for a VBAC to progress is spontaneously and without augmentation

and i would be wary of delivery at 38 weeks by el section

the hospital i am involved at will often book a post CS repeat section at 41 + to give the mum time to labour, or at 42 weeks if she wants to go for VBAC

if the mother does not want a VBAC, then a section will be booked around 39 weeks.

there is also a VBAC clinic available to refer women to

induction will also be offered but not early unless other indications.

What Lulu says. This is very, very odd. Only a very small fraction of women will go into labour at 38 weeks. Does this mean you have to have a C-Section if you haven't gone into labour by then? I'd ask to see the research guiding this policy because there's plenty of counter-evidence.

I bet there is evidence to say more scars rupture after 38 weeks than before - but that will be because as Lulu says it's the labour that puts strain on the scar and very few women would be labouring before 38 weeks! Therefore any 'evidence' of that sort would have a flaw in it you can drive a truck through