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Re: VBAC and augmentation without ruptureFrom: Betsy Hyde (elishyde@connix.com)Thu Aug 8 20:56:49 1996
> >Jokes aside, may I tap your varied experience on using Syntocinon after a >previous Caesarian Section ( a trial of scar or attempt at VBAC) >Some say NEVER EVER. Does this mean even if contracting irreg 1 in 6 or 8? >Some limit the amount of Synto.. If you do, whats your limit? >Some use an Intra-uterine Pressure Catheter (an IUPC in UK). >This is really the main question: >**What IUPC pressures do you or your colleagues aim for? I believe that the literature supports use of oxytocin (syntocinon, pitocin) for dysfunctional labor with prior c/s...given the caveat that with clinical evidence of cpd it is not a good idea to push too hard! We use with previous c/s as we use with unscarred uteri. I am a member of a collaborative MD/CNM practice in which the CNMs attend all labors and vaginal births.(and are photographers at the cesarean births!) The MDs are available for problems which may occur during labor, although labor augmentation without consultation is within the CNMs' protocols . We consult when augmentation of labor does not result in progress. Our births occur in a tertiary care facility. Approximately 10% (ranges from 5-13%) of the women *I* attend in labor have c/s. Our VBAC rate is about 75%. We have never had a ruptured uterus in labor during my tenure (12 years x 450 births/year)...all our ruptures have been in early labor at home. I treat moms with previous c/s just as I treat other laboring women...ie, no continuous monitoring, no ivs, ambulation and position changes, avoid epidurals, etc. If labor is not progressing, I try to consider why. Which of the Ps needs changing....powers, passenger, passage, psyche? If labor is not progressing,I have tried all the standard tricks, and I am concerned, I am a firm believer in IUPCs. I think they are both diagnostic and therapeutic. If there is an arrest of labor, and contractions are >50 mmHg and <q 2-3 minutes, I would be suspicious of CPD and not want to push with pitocin if previous c/s. If IPUC shows contractions <50mmHg or >q2-3 minutes, I would feel comfortable with augmentation.I think IUPCs are a great tool if labor is not progressing normally. When we use IUPCs, we aim for 50 mmHg q 2-3 minutes in the absence of clinical indicators of CPD. (after all, uterine inertia is often a protective mechanism if CPD.) Elisabeth Hyde CNM MSN Branford, CT Assistant Clinical Professor Yale University Midwife in private practice
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