1. 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 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