Recent birth - unanswered questions

feebebe23 · Mar 19, 2008

If mom had ever had a D&C....either miscarrage or abortion (which she may not have disclosed) can cause scar tissue on the cervix. Also.....if mom is SROMed for 36 hours I have no doubt she had signs of chorio....

Also....if she made it to 9cm that means the scar tissue band broke open and thus only made her labor longer and did not effect her ability to have a lady partsl delivery.

I have seen the cervix swell mostly with transverse positioned babies....which would explain not going past 9cm.

Since the scar tissue opened I would think if this type of patient wanted to VBAC she would labor like a multip.....just hope for a smaller LOA baby....

I also hate to say it.....but being ruptured for 24 hours prior to starting pit did NOT HELPTHIS MOM....

I get the whole anti-pit all natural thing...give me a non-infected baby anyday!!!

CEG · Mar 20, 2008

As far as the infection, whether or not she was in the hospital for that 24 hours prior to the pit would have a huge effect on whether infection was a big factor. If she was in the hospital and/or had multiple lady partsl exams she was far more likely to become infected than if that was not the case. In cases where lady partsl exams are not performed with PROM the risk of infection is very low.

OzMW · Mar 20, 2008

As far as the infection, whether or not she was in the hospital for that 24 hours prior to the pit would have a huge effect on whether infection was a big factor. If she was in the hospital and/or had multiple lady partsl exams she was far more likely to become infected than if that was not the case. In cases where lady partsl exams are not performed with PROM the risk of infection is very low.

Very low actually, obstetric interventions like VEs play a big role in infections with PROM. She may very well have been better off waiting another 24 hrs; at home....... :coollook:

Kiwimid · Mar 23, 2008

i agree with the others on this one.....the more ves the greater the chance of infection . i had one of my women get to a certain point and then just stop. i just want to know as a student why not do something else rather than a c section....i mean 9 is pretty close? why not try and stretch it just that bit further....surely that would be better than a c section???

justme1972 · Mar 23, 2008

i agree with the others on this one.....the more ves the greater the chance of infection . i had one of my women get to a certain point and then just stop. i just want to know as a student why not do something else rather than a c section....i mean 9 is pretty close? why not try and stretch it just that bit further....surely that would be better than a c section???

Rule #1 in L&D: The baby or the mother should never be compromised in order to avoid a c-section. Once signs of infection set in, time to deliver.

Most mothers, if you ask, would take a section any day in the week if their baby was at risk, even low risk.

If I was that mother....I would have been demanding a section long before.

Yes, c-sections are on the riise, but it's because physicians aren't taking chances like they used to, and infant mortality rate is dropping because of it.

CEG · Mar 23, 2008

Yes, c-sections are on the riise, but it's because physicians aren't taking chances like they used to, and infant mortality rate is dropping because of it.

I don't believe our infant mortality rate has improved in about 20 years. And actually infant mortality would not be the statistic to use- it would be neonatal or perinatal. Do you have a source for that?

CEG · Mar 23, 2008

I can't edit my post from above but I wanted to add some info sources:

US Neonatal Mortality is 2nd Worst in Developed World: http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/index.html

Maternal Mortality Rate has not improved since 1980: http://mchb.hrsa.gov/chusa03/pages/status.htm

Definition of Infant, Maternal, perinatal, etc: http://www.cdc.gov/NCHS/datawh/nchsdefs/rates.htm

Only very slight improvement in Neonatal death rate since 1980: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5508a10.htm

Report showing slight improvement in Neonatal Death rate since 1990, others no change: http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_06.pdf

Risk of Neonatal death with C-sections higher even in the absence of other risks: http://www.news-medical.net/?id=19919

It's important to remember that while a c-section can be an important, life-saving operation it is also a procedure with risks and benefits that must always be weighed against the risks and benefits of a lady partsl delivery. It is not an automatic "safe" choice- and the US's statistics reflect that our overuse of c-sections and other technology is harming, rather than helping, women and babies.

HeartsOpenWide, RN · Mar 23, 2008

I don't believe our infant mortality rate has improved in about 20 years. And actually infant mortality would not be the statistic to use- it would be neonatal or perinatal. Do you have a source for that?

from what I have read our infant mortality is worsebecause it it.

OzMW · Mar 23, 2008

Rule #1 in L&D: The baby or the mother should never be compromised in order to avoid a c-section. Once signs of infection set in, time to deliver.
Most mothers, if you ask, would take a section any day in the week if their baby was at risk, even low risk.
If I was that mother....I would have been demanding a section long before.
Yes, c-sections are on the riise, but it's because physicians aren't taking chances like they used to, and infant mortality rate is dropping because of it.

I agree! But the trouble is one or two high temps don't prove an infection! Which is what we see all the time. The just in case scenario; which is B.S.We are teaching women to go for the section "just in case"! Too bad about the wound infection and the adhesions that she may have to face because of "just in case". That I'm sorry is a big load of crapola. And from what I've seen, the amount of fiddling with labours that people seem to mention round here, no wonder there needs to be "just in case" intervention! Sheesh, and of course routine continous EFM is just in case too! Now how many iatrogenic caesarean sections does that cause? But its just in case eh!

And sorry infant mortality is the wrong stat. That would be perinatal mortality. And what about maternal mortality? And morbidity?

OzMW · Mar 23, 2008

http://www.npsu.unsw.edu.au/NPSUweb.nsf/resources/MD_94_97_00/$file/MD2002_02.pdf

This is a report from Australia (where we have an appalling CS rate) on maternal deaths. Now if you go to the end of the report there is a chapter on CS and it is a bit wishy washy on how CS impacts on maternal death rates. Go back to the lists of complicating factors with these women that died,it is glaringly obvious that for many of them, CS; often a past one, impacted somewhat on the outcome. Placenta previa/acccreta comes up often. Now this obviously says not much because we don't know the exact histories of each of these women, and the death rate is VERY low; but it does show that CS is not the easy out procedure that we often site it to be.

And apologies if I seemed abrupt in my last post, this is a topic that I am passionate about. I have seen SO many occasions where Drs and midwives have pushed CS onto women because of the just incase, we can't guarantee the safety of your baby line......

Elvish, BSN, DNP, RN, NP · Mar 24, 2008

Me personally, I had a temp of 103 as I was pushing. Nobody rushed me back to the OR, nobody even suggested it! Lots of moms run temps in labor. Though it certainly CAN suggest infection, that's not a given.

Maybe it's because she's got an epidural. They are notorious for causing fevers. Maybe it's because she's not allowed to have anything to eat or drink during labor and she's dehydrated. IV fluids just aren't the same.

Part of supporting women before, during, and after birth is looking at the whole picture. Not just one elevated temp, or one decel, or one ANYTHING.

That said, uterine infection (if there was one) CAN cause a marked increase in pain. And it may have been that she was feeling that pain vs. the contractions. But I can't really say for sure as I wasn't there....