Re: [ozmidwifery] Question of the week.

Sat, 05 Aug 2006 06:59:50 -0700

Like all these things we can all tell stories that support both sides of the equation. I personally know of a baby whose spinal defect was at the base of the skull. The a/n ultrasounds showed that the brainstem was herniating into the meningocele and the parents were told it was incompatible  with life and 'advised' to terminate the pregnancy. They declined and at term were advised to have an elective LUSCS for the reasons stated. They again declined and when the baby was born she didn't die at birth despite the dire predictions and they took her home. When at 10 days she was thriving they took her to RCH for assessment where they found that the spinal cord and brain stem had been returned to the correct position during the birth process without damaging it.  The defect was closed and Alice is now a thriving 5 year old who is defying all odds as to her potential.

As in all things the parents need to be given both sides of the story and then their decision respected because no two situations are exactly the same and you dont get to do it both ways and decide which one works best. Most practitioners are biased by their past experiences and often dont make objective recommendations to parents
Just another side to the story
Andrea Quanchi.
On 05/08/2006, at 10:45 PM, Susan Cudlipp wrote:

Mary, I would say that the meningocele is far more delicate than the bowel and if it is ruptured the long term prognosis for the child with spina bifida is compromised, whereas if it is kept intact the child stands a far better chance of living a normal life.  I know of a child, now 7years old, who was born by el C/S with us because of spina bifida.  He has done extremely well and you would hardly know that he had been born with a quite large neural tube defect. He has fully functioning motor system, and just a few fairly minor toiletting issues which are improving.  He was handled very carefully by a very experienced midwife and doctor and has really had the best outcome possible. I saw him at birth and know his parents so have had opportunity to follow his progress.
During vaginal birth it is not possible to guarantee protection of the meningocele, which could easily rupture with the pressure of even the gentlest passage through the birth canal, and therefor, for the child's sake, C/S is probably a better option.
Gastrochises I have seen and birthed vaginally are much more robust, while they still require careful handling there is not so much danger of long term, permanent damage.  The bowel is not in the same ball game as the spinal cord.
 
Regards, Sue
----- Original Message -----
Sent: Friday, August 04, 2006 4:36 PM
Subject: RE: [ozmidwifery] Question of the week.

Would this be any different to a gastrochesis, where loops of bowel are hanging out of the abdominal cavity.  A clients baby was born this week with quite a lot of bowel protruding.  Other than the need for sterility, it was a normal birth.  MM

 

From: owner-[email protected] [mailto:owner-[email protected]] On Behalf Of Ken Ward
Sent: Friday, 4 August 2006 2:27 PM
To: [email protected]
Subject: RE: [ozmidwifery] Question of the week.

 

I have seen large and small spina bifida's birthed normally. It is important to keep the membrane intact to prevent infection. These babies are usually operated on very quickly.

-----Original Message-----
From: owner-[email protected] [mailto:owner-[email protected]]On Behalf Of Mary Murphy
Sent: Thursday, 3 August 2006 10:03 PM
To: [email protected]
Subject: [ozmidwifery] Question of the week.

An interesting question from Midwifery Today E News. I am 21 weeks pregnant with my third child, which has been diagnosed with spina bifida. This is quite a shock since my other two children were homebirths and the specialists said I would require a c-section. I understand the need to deliver in a hospital where the baby can receive immediate medical treatment soon after birth, but does anyone know if there is any evidence that c-section is better than vaginal birth when delivering a child with spina bifida?

 

 



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