In recent years in the United States and other countries, malpractice suits have been filed against physicians, nurses, and hospitals in response to perinatal injuries or infant deaths that resulted from a uterine rupture when women were laboring for a VBAC.

Although the risks of a uterine rupture with a prior low-transverse uterine scar are not higher than the unanticipated risks of other complications that may arise during childbirth, in some communities, women who wish to try for a VBAC rather than schedule an elective repeat cesarean are often expected to assume responsibility for any or all negative outcomes.

To lower the risk of liability, some malpractice insurance companies in the United States have developed VBAC consent forms that physicians are required to discuss with patients who wish to labor after one or more cesareans. Some of these consent forms overstate the risks for laboring for a VBAC or minimize the risks for planning an elective repeat cesarean.

In the interest of providing a balanced view about the risks and benefits of planning a VBAC or scheduling a repeat cesarean, women and their care providers are encouraged to consider the following VBAC information and consent document.

Information and Consent for Women with a Prior Cesarean Section(s)

The purpose of this form is to provide information regarding vaginal birth after cesarean (VBAC) to mothers who have previously had a cesarean and to provide an opportunity for the mother to choose VBAC after discussion the obstetrician or provider. Please read the following information carefully, discuss your concerns with your obstetrician or provider, initial your choice, and sign this form in the area indicated below.

All mothers who have had one previous low transverse cesarean section are encouraged to attempt a vaginal delivery unless the physician indicates otherwise. VBAC is also a reasonable option if your previous records cannot be obtained and it is unlikely that you had a classical uterine incision. Successful, uncomplicated vaginal birth after cesarean (VBAC) carries the lowest risk to both mother and baby as compared to repeat cesarean section. However, I understand that if I choose a VBAC and end up having a cesarean during labor, I have a slightly greater risk of problems that if I had had a cesarean without labor. Not all women will be able to have vaginal birth after cesarean section. The success rate for those attempting vaginal delivery after a previous cesarean section is about 75%.

The most serious complication of attempting a VBAC is uterine rupture, which occurs in about 1% of cases. In the case of uterine rupture, internal and /or external bleeding may occur and may require blood transfusions and/or hysterectomy. Rarely, fetal injury or death may also occur.

Elective repeat cesarean (the alternative to VBAC) also has some risks. Cesarean section is a major operation and in some cases there can be injuries to the mother's bladder or bowel or other serious complications.

Patients who have had more than one cesarean will not be discouraged from attempting vaginal birth if they request. However, there may be a slightly increased risk of uterine rupture in this group.

I have read or have had read to me the above information and I understand it. I have discussed the alternatives with my physician or provider and I have received all the information I want.

*Dr. Flamm is the author of several VBAC studies, Birth After Cesarean: The Medical Facts, co-author of Reducing Cesarean Section Rates While Maintaining Maternal and Infant Outcomes, and Co-editor of Cesarean Section: Guidelines for Appropriate Utilization. He chaired the Institute for Health Care Improvement's Reducing Cesarean Section Rates Collaborative and is currently Area Research Chairman, Obstetetrics and Gynecology at Kaiser Permanente, California.

Click here for printable version of the Consent Form [acrobat pdf]

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