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

[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 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

[morte, LPN, LVN]

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

[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 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.

[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 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.