Birth Acadiana Podcast

Episode 79: VBAC Epidural Hospital Policy


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I’m your host and local perinatal chiropractor Dr. Alayna Clark joined by my dear friend and co-host and Doula Tiffany Wyatt, we’re here to bring you a treasure trove of knowledge, wisdom, and personal stories. 

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VBAC Epidural Episode: Key Citations & SourcesACOG Guidelines

"Epidural analgesia for labor may be used as part of TOLAC" (not required)

  • ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery (2019)
  • https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/02/vaginal-birth-after-cesarean-delivery

73% success rate overall; 78.2% with epidural vs 76.8% without epidural

  • Evidence Based Birth Podcast Episode 113: https://evidencebasedbirth.com/ebb-113-the-evidence-on-vbac/
  • Israeli study (17,516 women): https://pmc.ncbi.nlm.nih.gov/articles/PMC12176991/

70% detected by fetal heart rate monitoring; only 10-15% by maternal pain

  • StatPearls - Vaginal Birth After Cesarean Delivery: https://www.ncbi.nlm.nih.gov/books/NBK507844/
  • StatPearls - Uterine Rupture: https://www.ncbi.nlm.nih.gov/books/NBK559209/

0.7-0.9% regardless of epidural use

  • Multiple studies show no significant difference between epidural and non-epidural groups
  • French study: https://pubmed.ncbi.nlm.nih.gov/28622143/

Finland/Sweden/Netherlands: ~50% VBAC rate; US/Australia: ~12% VBAC rate

  • None of the high-rate countries mandate epidurals for VBAC
  • Transforming Maternity Care (Australia): https://www.transformingmaternity.org.au/2021/07/strategies-that-work-to-increase-vaginal-birth-rate-after-caesarean/

General anesthesia: 3-5 minutes; Epidural conversion: 10-15 minutes

  • For true emergencies, general anesthesia is faster and standard practice
  • StatPearls - Uterine Rupture: https://www.ncbi.nlm.nih.gov/books/NBK559209/

VBAC Success RatesUterine Rupture DetectionUterine Rupture RatesInternational VBAC RatesEmergency Anesthesia

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Birth Acadiana PodcastBy Birth Acadiana-Dr. Alayna Clark and Tiffany Wyatt