Re: [ozmidwifery] Trial of Scar

Thu, 06 Jul 2006 20:09:18 -0700

My sister had a lscs for pih / failed induction (don't ask) and then went on to have a failed attempt at a VBAC (same Dr) he noted a thin lower segment. I agree with the natural state theory and discussed this thought with my sister, as the dr advised her not to have any more children suggesting that she was at risk of uterine rupture.
She has since moved to Brisbane, had another lscs, and the OB never mentioned anything unusual with her uterus.
 
She is now trying to fall pregnant with her 4th.
 
megan
----- Original Message -----
Sent: Friday, July 07, 2006 12:04 AM
Subject: Re: [ozmidwifery] Trial of Scar

One thing I have seen a lot of is Obs stating in the operative notes that uterus was 'very thin' or 'translucent' and using this as justification for the repeat c/s
One lady recently was wanting vbac very badly - came in in early labour i.e. not really established, at T+10. Got ARM'd - 2cms dilated, mec liquor ( not unusual post dates) CTG'd - nothing sinister on the trace, but a few hours later was told she needed c/s for fetal distress!  Still not even in established labour, and I could see no evidence of fetal distress on the trace.  The ob wrote 'translucent lower segment' on the notes. 
Apart from the total b.s. of her needing a repeat c/s this was so obviously a decision made by the ob without her understanding or ability to question his decision ( I was not there - talked about it with a colleague and we looked through the notes).  Result is a woman who feels very aggrieved and disempowered.
If she had had more knowledge and support she may well have had the ability to say no to the ARM and continuous monitoring, question what was deemed to be fetal distress on the monitor, and even not come in that early in her labour or go home again to establish.  Instead she has had a second uneccessary c/s and is heading for a second bout of PND.
Anyone have any comments on these 'thin lower segment' claims?  My belief is that it is probably a normal state for the lower segment but 'they' see it as a sign of imminent rupture (of course if they weren't about to slice into it they wouldn't be able to see how thin it was)
 
On a slightly different tack - can anyone point me to the latest thinking with active vaginal herpes lesions?  Automatic c/s, or is there an alternative option?
 
TIA Sue
----- Original Message -----
Sent: Thursday, July 06, 2006 12:37 PM
Subject: Re: [ozmidwifery] Trial of Scar

When women tell me they were C/Sd for FTP I always explain this to them as "your baby just couldn't come out because...............??? I am looking for further information from them or imparting what I know of the situation which led to their surgery.
I do NOT say: "you didn't dilate" ie it's your fault that your Cx 'failed' to open, or the baby to descend etc. Apportioning blame is not a productive exercise here.
 
FTP is a 'blanket term' for heaps of things as Janet says.
It would be much more helpful to the women in understanding what's happened to them if we isolated the problem & specified it rather than put it all under 1 heading which by its very wording assumes the mother is somehow at fault !
 
With kind regards
Brenda Manning
www.themidwife.com.au
----- Original Message -----
Sent: Thursday, July 06, 2006 1:36 PM
Subject: Re: [ozmidwifery] Trial of Scar

There's a thread on JB called "FTP? FTW?" which has research on it and how FTP is, oddly enough ; ) not something normally recognised or "diagnosed" in midwifery. FTP is one of the main reasons in Australia for c-sec, the other two reasons being breech and previous surgery. Shocking.
J
----- Original Message -----
Sent: Thursday, July 06, 2006 1:35 PM
Subject: RE: [ozmidwifery] Trial of Scar

I’d love to use all three but I will stick with the one that women know well – most of the birth stories in our forum have that in it, unfortunately…

 

Best Regards,

Kelly Zantey
Creator, BellyBelly.com.au
Gentle Solutions From Conception to Parenthood
BellyBelly Birth Support - http://www.bellybellycom.au/birth-support

From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Janet Fraser
Sent: Thursday, 6 July 2006 1:18 PM
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery] Trial of Scar

 

It's really "failure to wait" and "failure to stop poking about"...

----- Original Message -----

Sent: Thursday, July 06, 2006 1:19 PM

Subject: RE: [ozmidwifery] Trial of Scar

 

Oh yes we are having a big discussion about the wording after that post, and I told everyone I am going to write an article:

 

“Failure to Progress: Why Doctors Need to Move On”

 

LOL!!!! I will too ;)

Best Regards,

Kelly Zantey
Creator, BellyBelly.com.au
Gentle Solutions From Conception to Parenthood
BellyBelly Birth Support - http://www.bellybellycom.au/birth-support

From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Janet Fraser
Sent: Thursday, 6 July 2006 11:16 AM
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery] Trial of Scar

 

What a bloody crock. Yes, that's a common protocol to wave at birthing women who'd be doing just fine with a bit of evidence based care. I've heard limits of 38 weeks (yes, really!) through to 41 weeks on the time a woman with previous surgery is told she's "allowed" to gestate before being forcibly sliced open. It depends on the hospital and whether or not she employs a private surgeon.

Tell her to run for the hills if she wants to be safe. And don't get me started on the intrinsically offensive nature of that term... TOS - trial of service is what it really means!

J <- whose sister is currently labouring for her HBAC at 42+4 without ANY crap like that!

----- Original Message -----

Sent: Thursday, July 06, 2006 8:25 AM

Subject: [ozmidwifery] Trial of Scar

 

Just wondering what guidelines exist for trial of scar… a woman on my site said that she has been given until 41 weeks to give birth or she’ll be having another caesarean. Is this right? I am sure I have heard otherwise and seen otherwise…

Best Regards,

Kelly Zantey
Creator, BellyBelly.com.au
Gentle Solutions From Conception to Parenthood
BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support

 

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