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

[Mommi007]

hi there,

this is my first post::typing

i have been pondering about this for a while an have started my research on this topic..

i am a pre-nursing student and mom of a 16 month old son. i also have a neurological condition called syringomyelia or (sm). sm is essentially a fluid filled "cystlike" cavity in the spinal cord. sm can be associated with chiari malformation (cm). management in pregnant females and sm such as myself are quite tricky. we are usually told "c-section, under general...no lady partsl birth and no epidural".

[color=#111111]when it comes to patients with this condition, there is simply not enough research or concrete evidence that points to one absolute recommendation about delivery. the only research in this topic with pregnancy only covered 12 women... however there is some medical information that does support pushing during a lady partsl delivery can enlarge a syrinx and create a mass progression in the women's condition. the use of epidural is usually contradicted because risk of intracranial pressure and the use of a spinal is usually contradicted, but not completely contradicted. so i would like to explore here....and with your help

[color=#111111]i need some info on laboring options....particularly lady partsl delivery...without pushing...how can a women's ob, rn or other practioner assist her in this type of delivery?

[color=#111111]here is what i am thinking:

[color=#111111]we all know that if every woman explored this option, especially those women with conditions...labor and delivery rooms would be overflowing even more and things would not be as "scheduled". but just for this instance, in this particular patient, with no complications..non-eventful pregnancy and baby "looks great".

now..can a woman not push during labor(considering baby is tolerating labor well, tracings look great, no sign of distress, or lga, etc. etc.) the issue with the sm is the increase in intracranial pressure, and the valsalva maneuver and anything that causes in increase in abdominal pressure is an absolute contradiction in individuals with sm and chiari malformation.

i know it might take longer but does a woman really need to push a baby out...can she just let her uterus "do the work", and lady partslly deliver the baby that way. i know this essentially would occur in women who deliver a baby in a car on the way to the hospital, or before ob arrives to deliver. but has this "method" of delivery been done for a medical reason in ob patients, either with or without a medical condition. (such as syringomyelia or let’s say quadriplegia).

what about "laboring down", forceps assist, and vacuum assist...etc.etc

what have you had experience with in patients with similar situations? have you had a patient with sm or cm?

thank you

take care

trish, cna, asap (www.asap.org)

[ducknurse]

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.

[dishes, BSN, RN]

mommi007

I believe the doctor who said a patient suffered increased neurological loss and could not hold her baby following lady partsl 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

[morte, LPN, LVN]

mommi007

I believe the doctor who said a patient suffered increased neurological loss and could not hold her baby following lady partsl 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

[dishes, BSN, RN]

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

[dishes, BSN, RN]

A woman with syringomyelia who delivers a baby lady partslly 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.

[HappyNurse2005, RN]

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.

[CEG]

A woman with syringomyelia who delivers a baby lady partslly 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 lady partsl 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.