Hi Marilyn - I always love your postings! You reminded me of a case study I read some years ago of a woman who presented with very obvious haematuria in pregnancy. She had had two previous caesareans from memory. The diagnosed placenta percreta, which had extended into the bladder, the cause of the bleeding.
At caesarean, they cut off the cord flush with the placenta, and left it in situ to regress for a week (I think)- any attempt to remove it at the caesar would have resulted in major complications. They removed it a week later from memory and the woman was fine. If you think about abdominal pregnancy, the placenta usually has to be left in situ to regress because it secures itself to all sorts of places, and to remove it is impossible. So, after time it is slowly absorbed. I often wonder about the initiation of lactation though, and how these women and their babies fare. ----- Original Message ----- From: "Marilyn Kleidon" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Sunday, March 30, 2003 3:06 AM Subject: Re: [ozmidwifery] risks of 4th c/s and support for artificial feeding > Dear Lois, Lynne and others: > > I agree we must inform the women of these risks however they can be > accessed. AND we also need to make in-roads into the obstetric community. I > have spoken to several women postnatally who really wanted either a vbac or > a vaginal breech birth (multips with prior NVB's)but were scared off by > their ob. The ob's even used their lack of experience in these areas and > their extensive experience with c/s to justify the elective caesarean. One > young woman who had an emergency caesar for FTP and CPD due to malposition > was advised from immediately after that birth to have a repeat caesar and > when she persisted with her desire for a vaginal birth the dangers of > shoulder dystocia were brought up. So that now she is terrified if she tried > for a vaginal birth the baby could be damaged and she would never forgive > herself. These are women who really don't want major surgery but have been > made to feel that caesarean birth is the safest route for their baby and > feel they would be being selfish if they pursued a vaginal birth. Once the > fear and guilt are there it is so hard to override. So, I guess I am saying > the ob's are giving out misinformation which they may really believe, but > neverthless misinforms women. Somehow they (ob's, hospitals)need to become > afraid of doing unnecessary caesareans. I think we need some good research > that gets published in ob journals. > > marilyn > > ----- Original Message ----- > From: "Lois Wattis" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Friday, March 28, 2003 3:44 PM > Subject: Re: [ozmidwifery] risks of 4th c/s and support for artificial > feeding > > > > Dear Lynne and others on this subject > > I agree this information needs to be given to women antenatally in > whatever > > location they can be accessed. Problem is, women planning C.S. for > whatever > > reason frequently don't attend any antenatal education because they > consider > > they do not need it (not planning labour), so they are missed. Their > total > > exposure to 'education' is what they get from the ob (!!!) usually scant > at > > best. > > > > Another common situation is that they are not 'planning' another pregnancy > > so discount the potential consequences abnormal placental implantation in > a > > subsequent pregnancy. We all know some pregnancies occur - unplanned.... > > Women tend to hear what they want to, and discount the info they feel does > > not apply to them. I also find they (elective C.S. candidates) often know > > NOTHING of the potential risk for endometrial problems related to their > > scarred uterus.... another subject infrequently discussed in the "ob. > > education" process. Unfortunately, so many of the elective C.S. women are > > NOT making truly informed choices. (sigh) Lois > > > > ----- Original Message ----- > > From: "Lynne Staff" <[EMAIL PROTECTED]> > > To: <[EMAIL PROTECTED]> > > Sent: Saturday, March 29, 2003 6:53 AM > > Subject: Re: [ozmidwifery] risks of 4th c/s and support for artificial > > feeding > > > > > > The potential for placental problems does not seem to be discussed with > > women when they are booking in for repeat caesareans. When I speak with > > women who are having elective repeat caesareans, they seem unaware that > this > > may be a consequence of this choice. As a result of this, this information > > is included in antenatal classes when discussing caesarean birth and also > in > > the VBAC and caesarean class. > > ----- Original Message ----- > > From: "Marilyn Kleidon" <[EMAIL PROTECTED]> > > To: <[EMAIL PROTECTED]> > > Sent: Sunday, March 30, 2003 1:33 AM > > Subject: Re: [ozmidwifery] risks of 4th c/s and support for artificial > > feeding > > > > > > > Hi Sarah: I just wanted to add a note about the increased risks of > > placenta > > > previa, accreta, and percreta which are real risks to a populatiuon of > > women > > > who have had prior cesarean birth(s). However they really don't tell us > > > anything about this woman's actual risk. If she has had problems with > > > removal of the placenta after her previous cesareans then maybe this can > > be > > > checked out with u/s as this would tell us valuable info. We had a mum > in > > > for an elective repeat caesar the other week who had a known placenta > > > percreta (had been checked by u/s as having not grown through to the > > > bladder). There were extensive precautions taken to avoid an obstetric > > > disaster and they did. I think the risk of women having these placental > > > problems after c/s is a bit like women's risk of developing kelloid > > growths > > > after ear piercings: some of us will never develop them (0% actual risk) > > and > > > others will always develop them (100% actual risk), but we don't know an > > > individuals actual response until after the event, so all we can give is > a > > > population risk. > > > > > > I think an outcome of the increasing number of caesars occuring right > now > > is > > > this increased risk of retained placentas (accretas etc..) due to > uterine > > > scarring. Since we have not done this before I think we simply don't > know > > > what the risks of this particular outcome occuring will be. > > > > > > marilyn > > > ----- Original Message ----- > > > From: "Lynne Staff" <[EMAIL PROTECTED]> > > > To: <[EMAIL PROTECTED]> > > > Sent: Friday, March 28, 2003 1:16 AM > > > Subject: Re: [ozmidwifery] risks of 4th c/s and support for artificial > > > feeding > > > > > > > > > > Hi Sarah - has she considered labouring and giving birth? > > > > ----- Original Message ----- > > > > From: "sarah.darling" <[EMAIL PROTECTED]> > > > > To: "Ozmidwifery" <[EMAIL PROTECTED]> > > > > Sent: Thursday, March 27, 2003 4:03 PM > > > > Subject: [ozmidwifery] risks of 4th c/s and support for artificial > > feeding > > > > > > > > > > > > > Recent new subscriber here. I'm a community midwife in England and > am > > > > really > > > > > struggling to find research on the risks of a 4th c/s as opposed to > > any > > > > > other number c/s (i.e. what are the increased risks of a 4th c/s, if > > > any, > > > > so > > > > > that one of 'our' women can make a decision whether to try for a 4th > > > baby > > > > as > > > > > she has been told that 4 x c/s is 'too dangerous' - her quote). Also > > > does > > > > > anyone know of any research asking women whether, if they chose to > > > > > artificially feed their baby, they received support/teaching in > making > > > up > > > > > feeds, etc., singly or in groups. This is for a senior student and > her > > > > > dissertation. Really enjoying all the wisdom out there! Best wishes > > > > > Sarah Darling > > > > > [EMAIL PROTECTED] > > > > > Community midwife > > > > > > > > > > > > > > > -- > > > > > 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. > > > > > > > > > > > > > -- > > > 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. > > > > -- > > 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. -- This mailing list is sponsored by ACE Graphics. 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