When I was doing my reseach to get into the birth centre at RWH Brisbane I found the VBAC policy document from the Canadian College of OBs and Gynes. Their policy is the most comprehensive one produced by any of the Colleges including the American one. Interestingly the Australian College have not produced one at all - I rang them up and asked them!!
Anyway on monitoring it states:
"One of the most consistent early signs of scah dehiscence and/or rupture is an abnormal fetal heart rate pattern. Thus in cases of induction and/or augmentation, continuous electronic fetal heart rate monitoring is advised. Intermittent fetal heart monitoring is to be reserved for cases in which neither induction nor augmentation with oxytocin is performed"
Therefore if you follow this guide it is not necessary to use ECG on the majority of VBAC women as the majority are not induced. Therefore they should remain candidates for Birth Centres. Interestingly here in Brisbane is a "normal" woman is induced with oxytocin she is also transferred out of the Birth Centre for monitoring - therefore there should be no difference between VBAC and non VBAC women in their management. To see the full policy to to:
http://www.rcp.gov.bc.ca/Guidelines/Obstetrics/Master%5B1%5D.OB8.VBAC.May2000.pdf
Debby
>From: Carolyn Donaghey <[EMAIL PROTECTED]>
>Reply-To: [EMAIL PROTECTED]
>To: [EMAIL PROTECTED]
>Subject: Re: [ozmidwifery] vbac
>Date: Tue, 24 Sep 2002 21:02:38 +0930
>
>
>Hi Veronica
>Wow, you seem to have your work cut out for you. I will give you
>some good information to back up the validity and the antiquity of
>the term VBAC.
>
>Refer to the book Silent Knife: Cesarean Prevention and Vaginal
>Birth after Cesarean (1983) Nancy Wainer Cohen & Lois J Estner New
>York. This book is a must in the library of any midwife supporting
>vbac women.
>"In the 1970s, more studies substaintiated the safety of VBAC; yet
>women were still being sectioned more than 99percent of the time.
>Still, the winds of change were blowing. In 1974, Nancy coined the
>term "VBAC" and by 1975 she was hearing the acronym being used all
>over the country and was seeing it in medical articles as well. "
>page 94 Silent Knife
>
>The book is getting quite old now, but most of what is written still
>holds true today, and it is a confronting and challenging book to
>give food for thought.
>
>Congratulations Veronica on being informed and up-to-date with the
>last 3 plus decades ;-) .
>Carolyn
>PS I was under the impression that a woman who had never experienced
>pushing stage, would indeed push just like a first time mother.
>Certainly was the case for my vbac, took me ages to work out that oh
>this was pushing not more posterior labour DERR!
>Veronica Herbert wrote:
>
>>Dear all,
>>
>>
>>
>>Once again I had to "explain" and defend the use of the word VBAC.
>>The response I got today was "Well I'm not going to change what I
>>say!" When I said the term had been around since the late 70's
>>(somebody said that on here so I hope it's right lol) they said
>>they had never heard of it. Well they have now!!! I went home on my
>>tea break and printed off copies of the paper that Carolyn (hope
>>you don't mind Carolyn) wrote and I placed a copy in the postnatal
>>ward, labour ward, special care nursery, and the tea room.
>>
>>Another thing, we had a woman who was trying to have a VBAC today
>>and the Registrar that was on said she was only allowed to push for
>>20 minutes and then she was to have a vaccuum extraction, if she
>>hadn't pushed it out. Now I'm no expert on VBAC's but I thought
>>that that was a little unfair, since in her last labour she had
>>only got to 4cm dilated, and she had never been through second
>>stage. Any thoughts?/? By the way, she got to about 5cms and was in
>>good established labour managing well, had a V.E (was quite
>>disappointed that she was "Half way"), had pethidine, contractions
>>eased off and she went for a C/S!
>>
>>
>>
>>from Veronica Herbert
>>
>>(Midwifery Student, University of Ballarat)
>>
>> ----- Original Message -----
>>
>> From: Jo & Dean Bainbridge
>>
>> To: [EMAIL PROTECTED]
>>
>>
>> Sent: Monday, September 23, 2002 8:36 PM
>>
>> Subject: Re: [ozmidwifery] vbac
>>
>>
>> Dear Lynne
>>
>> It is good to hear that you don't use ECG for vbac. Could you
>> send me some policies regarding this (I hate policies but they
>> seem to be the 'in thing' at the moment and we need those who
>>LOVE
>> policies to start to listen.) Where do you work?
>>
>> We would also like some stats to back the success of vbac
>>without ECG.
>>
>> Could I send you a petition for your (obviously intelligent,
>>well
>> run, women focused) place of employment to sign. Our RANZCOG
>> state committee are trying their DARNDEST to get vbac out of
>>the
>> realm of normal and back into the good old High Risk category.
>>
>> Jo Bainbridge
>> founding member CARES SA
>> email: [EMAIL PROTECTED]
>>
>> phone: 08 8388 6918
>> birth with trust, faith & love...
>>
>> ----- Original Message -----
>>
>> From: Lynne Staff
>>
>> To: [EMAIL PROTECTED]
>>
>>
>> Sent: Monday, September 23, 2002 7:09 PM
>>
>> Subject: Re: [ozmidwifery] vbac
>>
>>
>> We don't use continuous EFM for women planning vaginal
>>birth
>> following caesarean, and they use the tub too. Yes, it IS
>>a
>> safe and 'viable' option for women, and the percentage of
>> women giving birth vaginally (since numerical values seem
>> to have more street cred than the experience, as far as
>> you-know-who is concerned) at our unit has consistently
>>been
>> in the high 80's to 90's.
>>
>>
>>
>> Passion of mine!!!
>>
>> ----- Original Message -----
>>
>> From: Jo & Dean Bainbridge
>>
>>
>> To: [EMAIL PROTECTED]
>>
>>
>> Sent: Monday, September 23, 2002 3:57 PM
>>
>> Subject: [ozmidwifery] vbac
>>
>>
>> hi everyone,
>> I am wanting to know if anyone can help with a
>>petition
>> being conducted
>> through CARES to maintain vbac is a safe and viable
>>option
>> in birth
>> centres. The word is that the new perinatal protocols
>> will be calling
>> for all vbacs to be monitored by ECG and thus will
>>remove
>> them from
>> birth centre care.
>> I have a hard copy petition and we are working on an
>> online version but
>> need to know if there is anyone out there that I can
>>send
>> the hard copy
>> to get some signatures? I am calling on the maternity
>> coalition
>> although I know everyone is busy with NMAP -I am
>>too!!,
>> and also others
>> who are willing to keep vbac safe from induction,
>> augmentation and the
>> other wonderful types of care that can increase the
>>rates
>> of rupture and
>> decrease the woman focused care.
>> Please help as we need to move quickly on this!
>> cheers
>> Jo Bainbridge
>> founding member CARES SA
>> email: [EMAIL PROTECTED]
>>
>> phone: 08 8388 6918
>> birth with trust, faith & love...
>>
>
