Labour Care Pathway for woman requesting VBAC outside the Delivery Unit Documented discussion of risks/benefits for VBAC under Midwife Led Care prior to onset of labour Positive VBAC POINTS Progress Essential On arrival absence of any new risk factors Baseline examination maternal/fetal wellbeing 1st Stage Labour Fetal auscultation 15 mins BP and temperature 4hourly Maternal pulse hourly, Contractions frequency& strength 4 hourly vaginal examination Urinalysis each void Monitor progress partogram Any Deviation in progress of labour Transfer must be made to delivery suite as soon as possible Any Deviation in progress of labour Spontaneous onset of labour Document using Partogram Consistent progress through labour is essential for successful VBAC 2nd Stage Labour Fetal auscultation 5 mins Maternal pulse 15 mins, BP 4hourly Contractions frequency& strength Urinalysis each void Maternal behaviour changes Confirm full dilatation with VE Confirm fetal position & descent Small PV fresh blood show External signs of full dilatation Expulsive contractions Lasts 60-90 minutes Maintain upright positions or forward leaning Maintain Fluid Intake & energy levels Use of water in pool or shower Support at all times Consent for method of management Physiological or Active Management Follow routine guidance as MLC 3rd Stage Labour Successful VBAC