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Informed Consent for VBAC

Easy Steps to a Safer Pregnancy - View e-book or Download PDF - FREE!
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.

Other excellent resources about avoiding toxins during pregnancy

These are easy to read and understand and are beautifully presented.

Since we talked about consent form for home VBAC several weeks ago, I decided to go ahead and write one for my practice. This is my working draft so far - comments are welcome, as is copying for your own use, if you wish.

Consent for Vaginal Birth After Cesarean Section At Home

1. I have had one or more previous cesarean sections (C/S), have records documenting a lower uterine segment incision, and desire a vaginal birth after C/S at home with my current pregnancy.

2. I have been informed of the following most recent (1994) guidelines from the American College of Obstetricians and Gynecologists (ACOG), which state that:

3. My midwife has informed me regarding:

A) The relative risks of VBAC:

B) The relative benefits of VBAC: I understand that, in the case of a complete uterine rupture, adverse consequences can be catastrophic in a matter of minutes. By choosing to have a VBAC outside of the hospital setting, I realize that I may not be diagnosed as quickly as having a potential rupture and that I may not receive emergency treatment and/or surgery as quickly as I would if I were having my baby inside of the hospital. It is possible that loss of time in transfer could be harmful or even fatal to myself and/or my baby.

4. After considering the above information, I believe that the benefits of VBAC at home outweigh the risks in my situation, and I choose to seek care with [midwife], [credentials], of [Business Name] and pursue a VBAC at home rather than in the hospital.
_____________________________________ ______________________________________

Client Signature/ Date Partner Signature/ Date

Midwife Signature/Date

This Web page is referenced from other pages containing related information about ICAN/VBAC/Cesarean and Is Homebirth Appropriate for a VBAC?


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