|
17/9/2002 23:28
|
Ilana Shemesh, natural midwife
|
מאת:
|
|
תשובות והסברים
|
כותרת:
|
VBAC is vaginal birth after Cesarian. VBAC is a complex issue, and depends on the reason for the Cesarian. Some VBAC's are very low-risk, and others have more risk involved. For example, a woman who had one Cesarian because of fetal distress, or breech, and then had other vaginal births that were totally uncomplicated is probably fine to do at home, as long as a hospital is nearby. However, a woman who had a long and hard labor, where she was not a victim of aggressive hospital management that might have labeled her wrongly as "failure to progress" and tells you that the baby stayed high the whole time, and was not big, tells me that maybe she has a small pelvis, and has a bigger chance of this happening again. So such a woman for me is not a good candidate for a homebirth. She is better to try another vaginal birth with a good midwife or doctor who will give her a good try for a vaginal birth in the hospital. If she suceeds, then perhaps her next birth she could try at home. The problem with a VBAC is that the uterus has a scar from the cut, and under unusual pressure labor has a very slight possibility
of tearing open during labor, and the results are very dangerous for mother and baby. Also there is more possibility of the placenta implanting on the scar area and having trouble detatching after the birth. The other problem is the political one and the medico-legal aspects. We homebirth midwives are working in a very hostile climate (lately it is much better)so we have to be very careful to follow all the rules so that we don't get our asses kicked and in the end harm ourselves and the future of homebirth. It is finally accepted that it is "OK" to homebirth if the woman is very low-risk. If there is a complication on a VBAC birth and we have to transfer to hospital, it will be a very difficult political situation for us. I have been fighting all my professional life, and I am a bit tired of fighting and sacrificing, so I need to draw limits as to just how much I am willing to endure. That is the main reason that I choose not to do most VBACS. However, if I do choose a VBAC (who suits my criteria)to birth at home, then I want an ambulance waiting and another midwife or doctor present for the birth. That enhances the safety net of such a "higher-risk" VBAC.As far as meconium goes this is the story. Most meconium is not because of fetal distress, but just happens, and is much more common in babies from 41 weeks and on. There are different degrees of meconium. Some is very light and thin and translucent like urine. Some is thick like pea soup or diarrhea or mustard. The thicker it is the more potential for problems (inhaling at birth) and causing chemical pneumonia and major respiratory problems. If the meconium is thin and the heartbeat is fine, I will continue to homebirth and just will suction the babies mouth and nose at birth.If the meconium is thick to begin with then homebirth is not a good idea. If all the labor the heartbeat is fine, and then the water breaks and she is near to birth and there is heavy meconium, then I will listen more carefully to the heartbeat, suction at birth, but not transfer since I'll probably be caught birthing her in the ambulance or car. Meconium stained water is not rare, and probably about 25% of births have this and it usually presents no problems. If there are dips in the heartbeat then there is more of a chance that the baby will gasp and inhale meconium in utero, which is also why you need to transfer with a combination of fetal distress and meconium.
As for going overdue: If you hit 42 weeks I advise inducing with castor oil or other less invasive ways like stripping or acupuncture. If that doesn't work, then yes go to hospital and homebirth is not a good idea. However, make sure that there is no date confusion and that you really are 42 weeks. Hope I have shed some enlightenment. Ilana
|
תוכן התגובה:
|
תגובות נוספות
|
