BENNINGTON—March 4, 2015—A pregnant woman’s choices regarding how to deliver her baby can be very personal. SVMC always tries to provide as many safe options as possible.
After a shift in national recommendations, Southwestern Vermont Medical Center Obstetrics and Gynecology (OB/GYN) reinitiated the offering of vaginal birth after caesarean (VBAC) in 2014.
“We are pleased with the safety of VBACs at SVMC and the success rates,” said Themarge Small, M.D. of SVMC OB/GYN. “We want more women with low-risk pregnancies to know that SVMC supports the choice to labor after a cesarean section.”
Until 1994, delivering children vaginally was almost universally encouraged, even if a woman had delivered a previous child by cesarean section. In 2006, safety data from the Amercian College of Obstetrics and Gynecology led many smaller health centers, especially, to perform only caesarean births for women who had already had a caesarean delivery.
More recently, the Northern New England Perinatal Quality Improvement Network (nnepqin.org) issued new guidelines for VBAC safety. Data showed that women who have had one previous caesarean section and who have few other risk factors may safely choose to labor and deliver vaginally.
John McLellan, MD of SVMC OB/GYN began practicing in Bennington in 1974. He has seen the pendulum swing towards VBACs, away, and back again.
“It is the right of the patient to select the route of her own care and to determine what she is willing to accept in terms of risk and benefit,” said McLellan.
Even after national data is clear and providers reach a philosophical consensus, a lot of coordination and training is necessary to implement a change like this.
“We worked with nurses in the Women’s & Children’s Department, anesthesiologists, the operating room staff, and pediatricians to make this a possibility for moms who present few risk factors,” remarked Small.
There is very careful monitoring for women who choose to labor after a caesarean. The primary risk is uterine rupture. The physician stays nearby throughout the entire labor. Staff are trained to recognize early warning signs and call for help if necessary.
It should be noted that certain factors may still cause a caesarean section to be necessary. If the progression of labor stalls, for instance, a mother may still need to deliver by caesarean section. Anesthesiologists and surgeons need to be close at hand.
Although most women who have had a caesarean section choose to deliver subsequent children in the same way, several women who have had caesarean sections in the past have chosen to labor and have delivered healthy babies at SVMC in the past year.
“From June 2014 through December 2014 there were ten patients who attempted a VBAC. Of these ten, six delivered vaginally,” said John Gottung, RN, director of Women’s & Children’s Services.
As the physicians at SVMC OB/GYN learn about a patient’s birth history, they explain the possibility of laboring after a cesarean. Many expectant mothers are surprised.
“A large proportion of patients are unaware that we offer this,” said Malcom Paine, MD, who also works in the practice.
Women who may have chosen to travel to get a VBAC can now receive the treatment they choose more conveniently.
“Whether a mom chooses to labor or have a second cesarean, every healthy mom and any healthy baby is a successful birth,” said Small. “We are all so pleased to be able to offer this choice.”
SVMC is a full-service community hospital that is part of Southwestern Vermont Health Care (SVHC), an integrated health system serving Bennington and Windham Counties in Vermont and nearby communities in New York and Massachusetts. In addition to the hospital, SVHC consists of the Centers for Living and Rehabilitation, the VNA & Hospice of SVHC, the SVHC Foundation, and the SVMC Northshire and Deerfield Valley campuses. It also includes Dartmouth-Hitchcock Putnam Physicians, a multispecialty medical group operated in partnership with Dartmouth-Hitchcock.