CONGRATULATIONS TO YOUR FRIEND, CAS!!! VBAC is a very special triumph. Hooray for woman power! Kind regards, Lois
----- Original Message ----- From: "Wayne and Caroline McCullough" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, January 23, 2003 7:50 AM Subject: [ozmidwifery] FW: [HBAC] VBAC after 5 c/s I just had to forward this on from my other mailing list [HBAC] on Yahoo Groups. This just goes to show how some women are just so amazing and how some doctors are so ignorant! Ps: friend of mine had her first VBAC yesterday, at home with MW and DH at 37 weeks after about 7-8 hours active labour. Baby weighed in at 7lbs. We are so proud of her! Cheers, Cas McCullough -----Original Message----- From: Leilah McCracken [mailto:[EMAIL PROTECTED]] Sent: Thursday, 23 January 2003 9:35 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: [HBAC] VBAC after 5 c/s Hi list- women's bodies are amazing (as are at least a few OBs). I had to put this on my site. Leilah --- An OB/GYN Thread that Ended in VBAC -with thanks to Angela Horn of homebirth.org.uk. Find the original posts from this 1996 thread beginning here- http://forums.obgyn.net/ob-gyn-l/OBGYNL.9603/0647.html ==== "Would be interested in response from the list to a request presented to me last week. The pt is 37 y.o. G6 P5 [sixth pregnancy, fifth child] with five prior low-transverse c/s. 1st section done for "CPD" with delivery of 4 lb infant. 2nd section "elective" repeat. 3rd section "elective" repeat. 4th section after failed VBAC. c/s performed after 45' in second stage with final Dx of "fetal heart rate abnormality and persistent OP" 5th section performed after pt had experienced 24 hr of ROM [rupture of membranes] without labor (records indicated hesitancy to attempt induction with four prior uterine incisions) She is VERY motivated to attempt VBAC. My inclination is to go for it, but I'm not sure about augmentation (even with IUPC) if failure to progress occurred. I'll be anxious to hear your opinions." Terri Rosenbaum, M.D. ====== "Terri: I would let her attempt a VBAC, and I would augment her if necessary. I don't know anything about your hospital and facilities, but the usual VBAC guidelines apply. I have always thought that most ruptures occur during the 2nd. stage of labor. In addition, she could have a uterine rupture with augmentation as a G5, regardless of the prior C/S history." Patrick S. Pevoto, M.D., FACOG ======== "A contraindication to pitocin is a contraindication to contractions. If you are willing to allow spontaneous contractions, then what is wrong with oxytocin induced contractions? A contraction is a contraction. The only diference is that you are doing something to bring about the contraction with the oxytocin. If properly administered and watched, there should be no more problem with pitocin induced contractions. [Note from Leilah McCracken, site editor: what an idiot!!] With this patient, if I were to allow her to labor or to be augmented, I would be there with my hand on her abdomen and probably watching the Intrauterine pressure monitor as well.. R.Daniel Braun, MD Clinical Professor Indiana U. School of Medicine ==== At 3:23 PM 31/3/96, R. Daniel Braun wrote: >A contraindication to pitocin is a contraindication to contractions. If >you are willing to allow spontaneous contractions, then what is wrong >with oxytocin induced contractions ? A contraction is a contraction. >The only diference is that you are doing something to bring about the >contraction with the oxytocin. If properly administered and watched, >there should be no more problem with pitocin induced contractions. "But you are interfering with the normal course of events and then if somethign goes wrong you have to accept responsibility." >With this patient, if I were to allow her to labor or to be augmented, >I would be there with my hand on her abdomen and probably watching the >Intrauterine pressure monitor as well. "I notice that you didn't write how you would deliver. Here she would get an elective Vaginal Bypass and we'd really strongly try and convince her to sign for T/L [trial of labor- TOL]." Dr. Eberhard W. Lisse ============ "I would not offer this patient a trial of labor for many reasons including liability concern." Douglas Krell MD ============ "I do a lot of VBAC yet without any data to back me, I would recommend repeat C/S in this case. She's already had a failed VBAC as well as her fifth C/S where someone told her it was best to not labor. There's a good chance you could prove that MD wrong, but there is also a chance you could prove him right. Chances are she'd do fine with a VBAC, but I think you are out on a limb if something bad happens, and bad things do happen. Be happy with a healthy baby and do the safe thing. If you do elect to proceed with TOL, I would give her a real TOL with pit and all. Watch closely, stay in the hospital, probably in the room. Good luck." Mitch Nudelman ======== "I would be hesitant to offer VBAC, but if patient insisted I would do it under double setup conditions. Pitocin question same as VBAC question- a "mild" trial of labor without pitocin if needed might not as well even be started. A recent USC study proved VBAC after greater than 1 previous C/S to be MORE dangerous than VBAC after one C/S (2% rupture rate). I've heard that those at USC no longer allow VBAC after greater than one C/S. Is this true? Any trojans out there?" Roland, M.D. Bemidi, MN, U.S.A. ======= >I would give her her trial - it's so rare to see someone motivated >after so many repeat cesareans. I would use epidural and oxytocin as >indicated. Good Luck! "I agree with Dr. Nagey. I admit, however, that there are no good data to support either decision. When confronted with similar patients, I discuss the benefit of VBAC with regards to 1 or 2 prior c/sections, and tell the patient that there really are no data with this many c/sections. We discuss the risk:benefit profile, and I'll do whatever she wants. In this situation, I can't argue with her choice for a repeat c/section, and I likewise can't argue if she wants a VBAC. I would consider a pressure monitor if you use oxytocin, and if I saw bradycardia or significant variables I admit that I would probably head for the OR. Please let us know how things turn out." Ashley Hill, M.D. ===== [a month later] "Geoff Klein reminded me I had not provided outcome data on the patient requesting VBAC after c/s x5. A few days ago, after a 45 minute second stage, a successful VBAC was accomplished. She was VERY proud of herself, and rightfully so! I'm sure the successful outcome wouldn't have been possible without such a motivated patient. I appreciated the input of the list, especially the obvious polarity of the replies." Terri Rosenbaum ===== "I did a VBAC on a patient with only 4 prior cesarean sections. After getting the records to show that they were low transverse cesarean sections, I let her labor (she was in favor of VBAC- I would not have pressed her to have a VBAC if she did not want to try labor). The first cesarean was done for failure to progress, the second for a breech, the third and fourth done because her last doctor insisted. She delivered without difficulty. This is anecdotal, of course, but in a closely monitored situation with the patient's informed consent and desire to attempt vaginal birth, I do not feel it is unreasonable medically or legally to attempt VBAC after multiple low transverse cesareans." Paul D. Burstein, MD FACOG Clinical Assoc. Professor Univ. of Wisconsin Milwaukee Clinical Campus ------------ Leilah McCracken <[EMAIL PROTECTED]> Mother of eight beautiful children, and the BirthLove website. <http://www.birthlove.com> Living the future of birth and parenting, today! `°º¤ø,¸¸,ø,¸¸,ø¤º°` http://www.InternetBabies.com The medical issues discussed are not intended as a substitute for consultation from your own health-care provider. `°º¤ø,¸¸,ø¤º°`°º¤ø,¸¸,ø¤º°`°º¤¤º°`°º¤ø,¸¸,ø¤º°`°º¤ø,¸¸,ø¤º°`°º¤ø,¸¸,ø¤º° Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/ -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
