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Need Your help... Vaginal Delivery Management & "NOT pushing"



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No. 10
from Mommi007
Old Sep 15, 2009, 12:09 PM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
Thank you so much for all your replies...hope they keep coming...Again the reason for this post is to gain knowledge and experiences and information to explore what is being done with Pregnant SM and or CM patients. It is quite difficult and almost unfair to be "all or nothing"...you know...If you have a vaginal delivery your baby will be brain damaged or if you have a c-section it's more risky to mom b/c of the spinal and or general anesthesia (ie. puncture and increased risk of intracranial pressure) because at the moment .....we really do not know....and that is what I am try to figure out. I kind of feel, that as an advocate for myself, and others with this condition and a healthcare worker....there are too many pregnant woman being told contradicting information, and I really am afraid that they are becoming human guinea pigs.

I mean you have one specialist telling one girl "no probelm, epidural okay, no problem pushing, vaginal delivery is okay"......But in the other hand this is the same physician that is telling you never to strain during a bowel movement...no sit ups....you get where I am going....



Then you have another specialist telling other woman, "C-section, General Anesthesia", and about how one of his patients had SM..had her baby...had a vaginal delivery...deliverd healthy baby...but "as a result" of the vaginal delivery and her condition, she could no longer hold her baby...She lost neurological function of her arm...Scare Tactic or Fact?

I had surgeon who specializes in this condition say... "C-section....spinal is okay"...So what is the damn answer?


I do not like (anyone in general), but especially woman with precious angels in their bellies being thrown around worrying throughout their whole pregnancies with these conditions (adding to even more worry to an even anxious mommy, and this is not even considering if they have other high risk conditions), whether they are making the "correct", safest, decision for both mom and baby. I guess that is why they call it practicing medicine?

I had one physician tell a pregnant mom w/ SM and CM "Go research this condition"...Are you kidding me?

I am really passionate about Perinatal medicine, especially when it concerns these two Neuro conditions.

Can't tell you how much your insight and knowledge means to me...thank you and thank you for all you do!

Please keep your input coming...Negative or positive.

Take Care
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No. 11
Old Sep 16, 2009, 01:31 PM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
Originally Posted by island40 View Post
The uterus is not strong enough to evacuate a baby with out the assistance of abdominal muscles. Failure to push during vaginal birth equal failure to progress. Forceps can cause damage to the baby. Vacuum can cause damage to the baby. continued stress on a baby from uterine contractions can cause damage to the baby. I think you would be hard pressed to find an ob that would take on the risks involved even if you pinky swore not to file a law suite once you had your precious brain damaged child in your arms.
Pretty harsh, and spoken like someone who is NOT an OB nurse...also very untrue. I've had several primips that I labored down, pulled back the covers and had a head crowning....uterus is very efficient!
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No. 12
from ducknurse
Old Sep 17, 2009, 08:01 AM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
I had a patient that who was a parapalegic(sp) following a car accident. She came in only b/c she was spotting; dilated 9 with BBOW. Few ctx's later SROM, and crowning. Of course I was the first one to get gloves on and 2 ctx's later delivered a beautiful baby girl. The patient never felt a thing!!! Never had the urge to push, never felt a ctx, nothing...her body did it for her.
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No. 13
from dishes
Old Sep 17, 2009, 05:26 PM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
mommi007
I believe the doctor who said a patient suffered increased neurological loss and could not hold her baby following vaginal delivery was likely stating a fact. The doctor has a legal and ethical obligation to give the patient informed consent and the doctor does not benefit from telling patients fictional scare tactics.

Dishes
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No. 14
from morte
Old Sep 17, 2009, 05:34 PM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
Originally Posted by dishes View Post
mommi007
I believe the doctor who said a patient suffered increased neurological loss and could not hold her baby following vaginal delivery was likely stating a fact. The doctor has a legal and ethical obligation to give the patient informed consent and the doctor does not benefit from telling patients fictional scare tactics.

Dishes
of course he would, the c section is more costly than the vag delivery
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No. 15
from dishes
Old Sep 17, 2009, 10:28 PM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
Originally Posted by morte View Post
of course he would, the c section is more costly than the vag delivery
Not quite sure how a neurosurgeon would benefit from a c-section being done. Patients with syringomyelia would likely consult with their neurosurgeons and their obgyn to understand their risks. Straining forces more CSF into the syrinx and can cause more neurological symptoms. A neurosurgeon who specializes in the area will tell the patient that pregnancy, labour and delivery can result in neurological deterioration in women with syringomyelia. The doctor who had a patient lose arm function is quite likely speaking the truth.

dishes
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No. 16
from dishes
Old Sep 19, 2009, 02:28 PM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
A woman with syringomyelia who delivers a baby vaginally without pushing may require the assistance of forceps or vacuum extraction, procedures that can cause perineal trauma. Damage to the perineum can lead to a weak pelvic floor and pelvic organ prolapsed. This in turn causes the women to strain to empty the bowel and or bladder, which can lead to continence problem that are unpleasant to deal with, but the bigger concern, is the effect straining has on the syrinx.
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No. 17
Old Sep 20, 2009, 12:42 PM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
Had a patient once who had to have a passive second stage because of a history of detached retinas. She had an epidural, and was not to push. She labored down, put her legs in stirrups, and the large baby came out very easily.

She was also a grand multip, though.

had a few pt's with epidurals not push and the baby came out or almost out.
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No. 18
from CEG
Old Sep 20, 2009, 01:09 PM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
Originally Posted by dishes View Post
A woman with syringomyelia who delivers a baby vaginally without pushing may require the assistance of forceps or vacuum extraction, procedures that can cause perineal trauma. Damage to the perineum can lead to a weak pelvic floor and pelvic organ prolapsed. This in turn causes the women to strain to empty the bowel and or bladder, which can lead to continence problem that are unpleasant to deal with, but the bigger concern, is the effect straining has on the syrinx.
The biggest risk factor for future incontinence is episiotomy. In the absence of episiotomy, women who have c-sections are actually at higher risk for future incontinence issues than women who have vaginal deliveries with or without lacerations. So future incontinence is not really a consideration (although many HCP spread this misinformation). The largest predictive factor for incontinence is genetics.
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