E4 “The Rules About VBAC” Part 2: A Deep Dive into US VBAC Guidelines with Jen Kamel

The VBAC Facts® Podcast

In this episode of The VBAC Facts® Podcast, Jen Kamel, founder & CEO of VBAC Facts®, delves deep into the specifics of ACOG's guidelines on VBAC (vaginal birth after cesarean) and elective repeat cesarean deliveries. The episode covers a range of topics including external cephalic version, epidurals, VBAC in rural hospitals, and who makes the ultimate decision regarding mode of birth. Jen provides a detailed analysis of the guidelines and emphasizes informed decision-making, patient autonomy, and the importance of ethical practices in maternal care. She also highlights the role of continuous fetal monitoring, managing complications, and the significance of sharing accurate information among clinicians and patients.

00:00 S1E4 ACOG VBAC guidelines

00:41 External Cephalic Version (ECV)

02:05 Pain Relief and Epidural Analgesia

03:29 Diagnosing Uterine Rupture

06:01 Manual Uterine Exploration and Dehiscence

07:59 VBAC After Uterine Rupture

09:21 Counseling After Previous Cesarean

12:03 VBAC in Rural Hospitals

28:11 Patient Autonomy and Informed Decision Making

43:45 Conclusion and Summary of Recommendations

Have a comment or question for the podcast? Want to suggest a guest we should interview or a topic we should discuss? Go to https://vbacfacts.com/podcast to give us your feedback!

VBAC Facts® resources

• Article: New study reveals surprising truths about the VBAC calculator: https://vbacfacts.com/2020/02/24/new-research-vbac-calculators/
• Article: Vaginal birth after three or more cesareans (VBA3C/VBAMC): An overview of the evidence

VBAC Facts® trainings

• VBAC Facts® professional membership: where we house a library of continuing education trainings including The Truth About VBAC™ Fetal Monitoring, The Truth About VBAC™ for Professionals, The Limited Evidence on VBA3+C: Decision Making in the Midst of Uncertainty
• Schedule an in-person training in your community at https://vbacfacts.com/speaking

Studies mentioned

• "One study cited about only 4 percent of uterine ruptures are associated with an intrauterine loss of pressure:" Nahum, G. G. (2016). Uterine Rupture in Pregnancy: http://reference.medscape.com/article/275854-overview
• "Dr. Mary Barger's 2013 study looked at all the hospitals in California that have 24 7 anesthesia:" Barger, M. K., Dunn, T. J., Bearman, S., DeLain, M., & Gates, E. (2013). A survey of access to trial of labor in California hospitals in 2012. BMC Pregnancy and Childbirth, 13(83). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636061/pdf/1471-2393-13-83.pdf

Other resources

• American College of Obstetricians and Gynecologists. (2019). ACOG Practice Bulletin No. 205. Vaginal birth after cesarean delivery. Obstetrics & Gynecology, 133(2), e110-e127.
• American College of Obstetricians and Gynecologists. (2016). Refusal of medically recommended treatment during pregnancy. Committee Opinion No. 664. Obstetrics & Gynecology, 127, e175-82. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/06/refusal-of-medically-recommended-treatment-during-pregnancy

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