VBAC Policy

[Noyac]

How many of you, that are not in training, have VBAC's at your facility and are required to remain in-house for the VBAC's?

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[Idiopathic]

Id be interested in hearing this. Apparently (I was told) in Oklahoma, none of the hospitals will allow them, so none of the physicians do them.

When I was at VU, however, they did them all the time, and we actually had a uterine rupture on my first epidural placement. She was on her second VBAC after 5 vaginals and one C-section (but my epidural help up)

Never seen a complication otherwise though.

 

[Noyac]

Maybe I should start with the question: How may of you guys are doing VBAC'S?

 

[militarymd]

we do.

 

[Noyac]

we do.

So are you in-house when on-call always? Only with VBAC's? Or not at all?

 

[militarymd]

So are you in-house when on-call always? Only with VBAC's? Or not at all?

If there is a laboring patient, we're there

 

[Noyac]

If there is a laboring patient, we're there

even if they are not a VBAC? Can't you put one of your crna's there and come in only when an epidural is needed or c/s?

 

[militarymd]

if only...we're working on it.

 

[Noyac]

if only...we're working on it.

Good luck.

This is the perfect crna job, IMHO. The MD does OB call and comes in to place the epidurals (don't let the crna place it) then goes home to leave the crna to manage it. If there is a c/s you come in to place the spinal and wait for the baby to be delivered then go home and let the crna finish. I know that this will piss off a few lurkers on this forum but the job of the crna/aa is a physician extender not a physician replacement.

If we are forced to be in-house for VBAC's I will then push to have a crna/aa on staff just for this reason only.

 

[militarymd]

Good luck.

This is the perfect crna job, IMHO. The MD does OB call and comes in to place the epidurals (don't let the crna place it) then goes home to leave the crna to manage it. If there is a c/s you come in to place the spinal and wait for the baby to be delivered then go home and let the crna finish. I know that this will piss off a few lurkers on this forum but the job of the crna/aa is a physician extender not a physician replacement.

If we are forced to be in-house for VBAC's I will then push to have a crna/aa on staff just for this reason only.

I concur, except I am ok with the physician extender doing the procedure, but with the physician immediately available.

 

[jetproppilot]

I concur, except I am ok with the physician extender doing the procedure, but with the physician immediately available.

Our call is from home...crna in house at all times. Come in at 2am, put in the epidural, go home.

Previous gig was like Mil's...come in, put in the epidural, wait til she delivers.

 

[zippy2u]

Use to love those locum jobs where the doc has to place the epidural and babysit it while it's in. I would sleep well at night making $180/hr. As a salary or fee for service situation, I'd get nauseated and go into convulsions just thinking about it. ---Zippy

 

[jwk]

We used to do a boatload of VBAC's, but since ACOG's guidelines changed a few years ago, we're down to a trickle. However, that also means our repeat C-Section rate has skyrocketed. I would guess we're looking at at least 35% or more for an overall C-Section rate, and although I haven't seen the stats, I would hazard a guess that of our previous C/S moms, 95% get repearts and 5% VBAC's, if that much.

We have a doc and two anesthetists in house at night as well as on weekends and holidays, more during the day and evening, with others available as needed. We place epidurals on 99.9% of our C/S. Rare spinals, no CSE's. All the epidurals are placed by the docs, and managed by the anesthetists. Virtually every C/S is done by an anesthetist. It's an extremely efficient practice, but with our volume, it has to be. (18,000 deliveries a year) We often have multiple C/S going, especially during the day with scheduled repeats, and I've seen as many as five going at a time, even at night.