Nursing management of labor and birth at risk 1. Laura is a 26-year-old G2P1 who had a cesarean delivery for fetal distress with her first pregnancy. Laura is now struggling with deciding between a repeat cesarean delivery or attempting a VBAC. (Learning Objective 9) a. In order to ensure that Laura has the facts to assist her in her decision, explain the risks of a repeat cesarean delivers b. Laura can’t understand why more women don’t want to try a VBAC delivery. Discuss the possible reasons for this. c. Describe the management of care for a woman attempting a VBAC delivery.

 Why Women do not Want to Try a VBAC Delivery
Vaginal birth after cesarean is an option of giving birth through the vagina after one had previously delivered through cesarean. This process is safe and successful for many women, but some women do not prefer it, and Some of the reasons as to why some women fear vaginal birth after cesarean is the fear of uterine rupture, a life-threatening complication occurring during the process, although it rarely occurs (Mujezinovi? & Anzeljc, 2021) Women may also fear vaginal birth after cesarean process due to the inclination for a planned cesarean birth and worries about the readiness of an emergency resources when a complication occurs during the process. A traumatic experience from a past cesarean delivery can make women have the fear of trying vaginal birth after cesarean. The determination on whether to perform a vaginal birth after cesarean is personal, and it is vital for women to acquire the appropriate information, resource, and support in decision-making on childbirth experience.

The Management of Care for a Woman Attempting a VBAC Delivery
Vaginal birth after cesarean delivery is a secure option for women having a past cesarean section and requires prudent care management. The management of care for a woman who wishes to try VBAC delivery begins with an evaluation of the history of her medication, including the reason that made her to deliver throuhg cesarean in the past, and the possible risk factor for the rupturing of the uterine and it is vital to ensure that the patient gets a supportive healthcare team involving an obstetrician who is experienced in managing vaginal birth after cesarean delivery (Familiari et al., 2020).  The patient should be informed of the risk and benefits of vaginal birth after cesarean delivery compared to a repeat cesarean process, including the perspective of natural vaginal birth. Continuous fetal monitoring is vital during labor times, where the obstetrician is always available to respond quickly in case of signs of rupturing the uterus or in case of fetal distress. In order to promote progress and reduce the risk of complications, the patient should be advised to move and change positions during labor, where pain management options are discussed and offered. The healthcare provider team must give close monitoring of the progression of labor to ensure the patient makes adequate progress in identifying any possible problems (Daminger, 2019). If a vaginal birth after a cesarean fail, a timely decision is made to continue with a repeat cesarean section ensuring the safety of both the mother and the baby. Managing care for a patient who wishes to try vaginal birth after cesarean delivery recommends a multidisciplinary approach and cautious attention to an individual’s care, communication, and clinical expertise.

Conclusion
The nursing management of pregnancy at risk is a vital aspect of offering safe and effective care for the mother and baby. Repeated cesarean delivery can lead to complications like infection, bleeding, and the patient taking a long time before recovering. Despite vaginal birth after cesarean being safe and effective, many women fear trying it due to fear and concerns, but with accurate management of care, which includes a thorough assessment, a healthcare team that is supportive, fetal monitoring, managing pain, close monitoring of the patient progression, an effective vaginal birth after cesarean can be achieved. Nursing staff plays a crucial role as they provide education, counseling, and supporting women who want to try vaginal birth after cesarean delivery ensuring the safety of the mother and the baby.