Page 20 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

Patients with the following factors may have a decreased

probability of success with VBAC:

• Recurrent indication for cesarean delivery (labor dystocia)

• Increased maternal age

• Nonwhite ethnicity

• Gestational age greater than 40 weeks

• Maternal obesity

• Preeclampsia

• Short interval between prior pregnancy and current

pregnancy

• Increased neonatal birth weight
42

The treating obstetrician should mitigate possible exposure to
liability by documenting the patient’s prior obstetrical history

concurrently with the latest prenatal assessment in order to
determine whether or not VBAC/TOLAC is reasonable. If the

previous cesarean involved a low transverse incision, this
should be clearly documented. All informed consent discussions

regarding risks, alternatives, and the possibility of converting to
a cesarean delivery must be thoroughly documented.

As we have previously discussed, informed consent is critical
to the defense of most obstetric malpractice claims. In regard

to VBAC/TOLAC, the documentation of informed consent is

crucial and must reflect that the patient has been carefully
and thoroughly advised of the risks, benefits, and alternatives
to VBAC. Physicians should supply patients with educational

materials that thoroughly explain VBAC and the associated

42 Id.

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