27 year old Beth and I spent about half an hour discussion her plan to delivery vaginally after a previous cesarean deliver (VBAC). Her first labor was long, she pushed for a couple of hours, but in the end it appeared that the 8.5 lb baby was just too big. Second babies are usually larger, and she has gained over 40lb, so what are the chances that this one will fit?
Current recommendations would have her schedule a repeat cesarean. Most complications from a cesarean delivery occur when there has been a long labor preceding the delivery. And a long labor increases the risk of the previous scar breaking open. This uterine rupture, not surprisingly, can be catastrophic for mom and baby.
If she had a previous breech that required a cesarean, and this baby was head-first and appeared average weight, then a VBAC would not be discouraged.
So we talk, and she continues to express desire for VBAC, but did agree to reconsider (at least I think she agreed to reconsider).
Then I noticed that she had refused both flu vaccine (safe in pregnant and important since pregnant women experience higher rate of complications from the flu) and the Tdap (whooping cough, diptheria and tetanus) vaccine, which can be deadly if the newborn (who can't be vaccinated for several months) picks it up from a family member.
Had I noticed this earlier, would I have changed my approach?
Sunday, January 27, 2013
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