Mrs. Madushika, 23-year-old Gravida 02 para 01, has been scheduled to see you at 38 weeks of gestation to discuss the mode of delivery.
Her last pregnancy ended up in emergency caesarean section and unfortunately the baby died on the 4th day due to meconium aspiration syndrome.
Her current pregnancy is otherwise uncomplicated and a thorough assessment reveals she is a suitable candidate for VBAC.
Your task is to discuss the delivery options, clear her concerns regarding the mode of delivery and allow her to make an informed choice.
You have 15 minutes to complete this station
001. Initiation of the interview
a. Uses name of the patient
b. Introduce yourself
c. Explain the purpose of the discussion
d. Be empathetic.
002. During discussion with the patient the candidate should find out or explain the following
1. Number of children she is hoping to have in future (if more –VBAC)
2. Her experience regarding the previous birth
3. Should explain what is VBAC and ERCS and why it is done at 39 weeks
4. The possibility of successful VBAC
I. 75% with spontaneous onset of labor
II. More likely in her case due to low BMI
5.Advantages of VBAC
I. Fewer complications than ERCS- Risk of maternal death 4/100,000.
II. Greater chance of a vaginal birth in future pregnancies
III. Quick recovery,
IV. Early return to everyday activities.
V. Shorter hospital stay
VI. Early establishment of bonding with the baby.
VII. Early establishment of successful breastfeeding
VIII. Avoidance of the risks of an operation
IX. Lower incidence of VTE
X. Lower incidence of neonatal tachypnoea
XI. Less maternal mortality 4/10000
6. Disadvantages of VBAC
I. 25% risk of unplanned Em. LSCS
II. Em. LSCS carries more risks than ERCS- e.g. higher need for blood transfusion.
III. Scar rupture – 1/200.
Warning signs of these complications- >do Em.LSCS.
In such circumstances, serious maternal and fetal consequences are
rare, but may be life-threatening to either or both.
IV. HIE or stillbirth is higher compared to ERCS
HIE VBAC-8/10000, ERCS – < 1/10000
V. Operative vaginal birth (can be up to 40%).
VI. Risk of 3rd or 4th degree perineal tear- 5%.
7. Advantages of ERCS
I. Virtually avoids risk of uterine scar rupture (1 in 1000).
II. It avoids the risks of labor and the rare serious risks to the
baby (2 in 1000).
III. The date of birth is planned.
IV. 10% chance of going into labor before this date.
8. Disadvantages of ERCS
I. Risk of maternal death 13/100,000
II. Compared to 1st LSCS, usually, operative time is longer /
May be more difficult / Higher incidence of damage to
bowel or bladder.
III. May need a blood transfusion.
IV. Higher risk of VTE
V. Longer recovery period and delayed return to normal
activities
VI. More likely to need ERCS in future pregnancies.
VII. ↑placenta accreta syndrome in future pregnancies.
(↑bleeding and may need a hysterectomy)
VIII. All serious risks increase with every caesarean section
IX. Higher incidence of neonatal tachypnoea
X. Accidental cut to baby’s skin at the time of caesarean
section (<2/100)- usually heals with no further harm
9. Management of Spontaneous onset of labor when already planned
for ERCS
I. Em. LSCS will be offered once labor is confirmed.
II. If labor is very advanced, vaginal birth may be safer and the
team will discuss with the patient.
10. Management of prolong pregnancy while awaiting VBAC
• If labor does not start by 41 completed weeks, following
birth options will be discussed again.
I. Await spontaneous onset of labor
II. IOL; ↑risk of scar rupture and lowers the chance of a
successful VBAC
III. ERCS.
003. Listening Skills Non/Verbal Communication
a. Maintains good eye contact
b. Has appropriate body posture
c. Makes empathic gestures
d. Is attentive to patient’s agenda
004. Attitude
a. Avoids condescending, or rude behavior
b. Appropriately non-judgmental
005. Questioning Skills
a. Speaks clearly and fluently
b. Uses language understandable to patient
c. Asks open-ended questions
d. Asks one question at a time
e. Controls the pace of the interview
006. Management Style
a. Does not make incorrect statements
b. Determines patient’s level of knowledge and educates appropriately
007. Closing of Interview
a. Summarizes what has been said
b. Emphasis she can have further discussions/explanations if she
wants.
c. Offer to talk with her husband later
d. Checks if there are any patient question
About the Author
