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Jo,
I would absolutely agree with
your first statement, heard it many times, "got in & saved/rescued your
baby, just in the nick of time" !
I am such a hero!
With the second part: whilst
very supportive of BAC I think labouring with a
uterus which has already dehisced & is subsequently heavily scarred is
really pushing the boundaries of safety.
However: as long as the
mother is well informed ( & being well informed means knowing the down side as well
as the up side) about the risks &
not intending to allocate blame if the outcome is
unfavourable ie a second UR ( hysterectomy etc, plus or minus
a fetal death) then she can do what ever she chooses.
I have seen in OT the
uterus of a woman booked for a repeat EL LUSCS, not in labour, 38/40 with
a dehisced area easily 5 cms in the old scar & no apparent ill
effects for mother or baby. Normal obs, normal CTG, normal fetal mvmts.
Absolutely no sign before OT that there was anything amiss.
Amazing.
She had been offered BAC &
chose LUSCS...............................what if ?
----- Original Message -----
Sent: Monday, January 23, 2006 11:15
PM
Subject: [ozmidwifery] VBAC
afterdehsicence or UR?
not
trying to be controversial (honest!) just wanting to think outside norm...how
many times have I heard the story of an ob saying to a woman when giving her
the repeat cs (for a 'failed vbac attempt not linked to a rupture) "oh the
scar was so thin it could have ripped open at any second...lucky I saved you
from it". (well I am TRYING not sound too facetious)
I
suppose like anything we must look at rationale for the first event. IF
a rupture did occur you could conclude that the repair to the uterus would be
quite extensive IF she managed to not lose the uterus- hence the risks
for future rupture would increase. But a dehiscence has not been proven
to be a serious concern according to the investigation I have done in the last
almost 9 years. There is speculation that a scar can slightly
part with no harmful effects.
Just
asking questions....don't they just HATE informed consumers!
;o)
love
Jo
You made all my points,
Jo.
: )
J
----- Original Message -----
Sent: Monday, January 23, 2006 8:46
PM
Subject: RE: [ozmidwifery] VBAC after
dehsicence or UR?
I would have to look for the research (we all know how 'fair'
research can be!) but the stated contra-indicators for vbac is previous
rupture. Now it doesn't actually state if the chances of another
rupture are higher than a normal scar or whether it is a case of
"dam! Not going to let that happen again!" attitude. You
could argue I suppose that even a dehiscence that required repair
would be considered the same as a repeat cs....?? Perhaps no vbac
after one rupture/dehiscence would be based on fear and/or
presumption. Similar to the situation where a woman loses a baby
during labour there is the assumption that she will want a cs next
time.???
jo
Hi all,
does anyone know of
research on VB after UR? I was asked this:
So if you've had a scar come apart
to the point where the baby was on its way out via the DIY sunroof, and
the ob says he would have had to cut me open to stitch it up even if I
had pushed the baby out, would that make VBA2C too risky?
Thanks in
advance,
J
Attending births is
like growing roses. You have to marvel at the ones that just open up and
bloom at the first kiss of the sun but you wouldn't dream of pulling
open the petals of the tightly closed buds and forcing them to blossom
to your time line.
~Gloria
Lemay~
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