Page 29 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

This case demonstrates the need for immediate OB physician

availability when the patient is undergoing a TOLAC.

The decision for a mother to have a VBAC and/or TOLAC is
a serious one for both the mother and treating obstetrician. It

is imperative that a mother who elects a VBAC or TOLAC be
completely informed of all possible risks and any procedure that

might result from a failed VBAC or TOLAC and the associated
risks of such. It’s also vitally important that every discussion

held with the mother regarding a VBAC and/or TOLAC be
thoroughly and completely documented in the medical record

by the treating obstetrician and any other healthcare provider.

In 2019, ACOG updated its Vaginal Birth after Cesarean Delivery

Practice Bulletin for the purpose of reviewing the risks and
benefits of TOLAC in various clinical situations and to provide

practical guidelines for counseling and management of patients
who will attempt to give birth vaginally after a previous cesarean

delivery. SVMIC has a sample TOLAC informed consent form
47
on the website.

Shoulder Dystocia

The majority of claims involving shoulder dystocia involve

allegations that the manual maneuvers applied by the physician
to relieve the dystocia were improper and/or excessive and

caused the injury. The truth is the occurrence of shoulder
dystocia is unpredictable and can happen with even the most

experienced practitioner. Shoulder dystocia is an obstetric

47 https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/02/vaginal-
birth-after-cesarean-delivery

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