Page 26 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

The failure to have both an obstetrician capable of handling

complications and an anesthesia provider physically present
and immediately available during the entire TOLAC can be

problematic to the defense of a claim. There should be clear
communication with the labor and delivery nurses regarding

when a physician should be consulted during a TOLAC.
According to the ACOG, “Because of the risks associated

with TOLAC and that uterine rupture and other complications
may be unpredictable, the College recommends that TOLAC

be undertaken in facilities with staff immediately available to
provide emergency care.” This typically means that a trained
45
physician and anesthesiologist be available on the premises.
It is important that the practitioner knows the hospital’s policy

on VBAC to ensure compliance. Otherwise, this could be used
against the physician in the event of a claim or lawsuit. When

resources for emergency cesarean delivery are not available,
ACOG recommends that obstetricians or other obstetric care

providers and patients considering TOLAC discuss the hospital’s
resources and availability of obstetric, pediatric, anesthesiology,

and operating room staffs with the patient. It is important
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to note that the definition of “immediately available” will be

decided by a jury in the event of a claim, and the term generally
implies no delay. Even when the defense demonstrates that

correct medical treatment was provided, a jury may often infer
that if the entire team including the obstetrician and anesthetist

had been immediately present, their intervention would have
prevented an adverse outcome. Let’s look at a case example:

45 https://journals.lww.com/greenjournal/Documents/Practice_Bulletin_No__184__Vaginal_
Birth_After.51.pdf
46 https://journals.lww.com/greenjournal/FullText/2017/11000/Practice_Bulletin_No__184_
Summary__Vaginal_Birth.42.aspx

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