Tuesday, May 5, 2009

Nothing too exciting

I've been on call this past few hours and not much has been going on. I did a couple first assists in the afternoon. Both were doc patients and repeat sections. I just admitted a young primip who's 3/90/0 at 40.5 weeks. I don't anticipate that I will need to run in as I think she is just getting warmed up. If she gets active, I will go for labor suppport as I know she was planning natural childbirth. Otherwise, nothing else going on.

I talked to a patient recently who has a history of two sections, with the last being 6 years ago. She wants to VBAC but no one is willing...especially in the area she lives in (which is a couple hours from us). Two of our three docs said absolutely no. The third was willing but that makes it difficult. If she comes in, in labor this doc would have to be on call, otherwise she would get sectioned. Not too mention there are some increased risks for TOL after two sections. I know that myself and the other midwives would be willing to provide care for her if she decides she wants to try it. Just a lot of variables that would have to fall in to place :( She's going to discuss it with her husband and let us know if she wants to give it a go. Of course, she could just show up 9 or 10 cms - then it probably wouldn't matter who was on call as they would likely allow a vaginal delivery at that point (this biggest risk of rupture occurs in early labor). Not that I am advocating that or mentioning it to her! We shall see what they decide.

Anyone out there do VBAC in this scenario?


Anonymous said...

"biggest risk of rupture occurs in early labor" -- Is there a study that shows this? Would like to know about it if so. Thanks, anon

Ciarin said...

This is actually what both my docs have told me when discussing VBACs - there is a ton of lit out there on uterine rupture so really don't have time to sort through it for you. Will check with docs when I go to the office today as to sources for that info :)

Joy said...

So what ended up happening with the momma?

Ciarin said...

Haven't heard anything back from her. I don't know what her plans are :(

On the lighter side of things, I just saw a momma who's last VBAC baby I caught, back with her next one :) She comes from a couple hours away to VBAC with us - such a shame no one in that area will do them !

Ethel said...

I had an instructor who did a VBACx2, and did well. Of course that was 17 years ago.