Episode 79: VBAC Epidural Hospital Policy
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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 [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/ [https://evidencebasedbirth.com/ebb-113-the-evidence-on-vbac/]
* Israeli study (17,516 women): https://pmc.ncbi.nlm.nih.gov/articles/PMC12176991/ [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/ [https://www.ncbi.nlm.nih.gov/books/NBK507844/]
* StatPearls - Uterine Rupture: https://www.ncbi.nlm.nih.gov/books/NBK559209/ [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/ [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/ [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/ [https://www.ncbi.nlm.nih.gov/books/NBK559209/]
VBAC Success RatesUterine Rupture DetectionUterine Rupture RatesInternational VBAC RatesEmergency Anesthesia
