VBAC Flashcards
pros of vaginal birth
vaginal flora exposure
can have more kids
vaginal birth helps prevent transient tachypnoea of the newborn
cheaper health economy
elective c/s can take a bit longer for lactation to establish
risks of VBAC
uterine rupture after 1 c/s is 1/200 but increases with subsequent c/s
emergency c/s
c/s before 28 weeks require a classical c/s, 100% cannot have a VBAC after this because youve gone through the body not the lower segment, because thee lowr segment does not exst yet at this gestation
when do you require a classical c/s
c/s before 28 weeks
after how many c/s is VBAC possible
possible after two c/s
three or more there may not b much lower segment left because each c/s takes out more segment
if scar rupture, there is a risk of death/hypoxic brain injury
sign of scar rupture
continuous pain between contractions
counselling for successful VBAC
risks with high BMI for unsuccessful VBAC
better off going into labour spontaneously
higher chance of successful VBAC with previous successful vaginal birth
find out at what point the pt had a previous c/s, earlier in labour is usually fetal distress, later is usually a pelvic issue which confers higher risk
non-pharm pain management measures
heat packs, positioning
electrical TEMS machine: fires stimuli to block pain receptors, works better in erly labour
pressure massage
hypnobirth
aromatherapy
strerile water injections
water birth: water immersion
pharmacological pain management
epidural
nitrous: NO2+O2
IV PcA: remifentanil
IM morphine + fenergen
oral - paraacetamol, codeine, tramadol
epidural
complications: hypotension, fetal bradycardia in response to hypotension, shivering even though they aren’t cold, itching
epidural has local anaesthetic
risk of nerve damage
risk that it won’t work
post-dural headache
CSF continues to leak out
what do you do if the CSF continues to leak out after epidural
take blood from the arm and use it to clot the epidural pucture
