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BreechFrom: CheriVH@aol.comFri Dec 22 20:24:07 1995
James Walker of Leeds reports an anecdotal case of an elective C/S for breech in which the mother arrested on the table. I have one, too. The first C/S I ever attended as an RN was a similar case. It was an elective C/S for breech and fibroids. The anesthesiologist was unable to get an epidural placed because of the mother's anatomy. He opted for a general. She aspirated blood and stomach contents during a failed attempt at intubation. The baby became bradycardic. While the anesthesia team desperately attempted to get her tubed, the section was begun under local anesthesia. The mother went to the ICU, where she was on a ventilator for 3 days. The baby (Apgars 1 & 5) went to NICU and eventually developed necrotizing enterocolitis from the asphyxia. I don't know what the longterm neurological outcome was. This experience definitely left an impression with me. I will never be able to consider Cesarean section as anything less than major surgery, with all its attendant risks. So I envy the doctor on the list who said he had never regretted *doing* a section, but he had regretted *not* doing one. I've seen at least this one which looked like a regrettable situation to me. In my previous practice my consulting physician did vaginal breech deliveries after sono and x-ray pelvimetry if labor was normal and EFW was >4000 gms. Parity was not a consideration. Outcomes with this protocol were very favorable. At my current institution vaginal breech delivery is not offered as an option. It is unfortunate that so many obstetricians are no longer being trained to feel comfortable with vaginal breech delivery. It is a wonderful skill and an option which should be made available as an informed choice for women who might want this type of delivery in preference to an elective surgery. Cheri Van Hoover, CNM Redwood City, CA Kaiser Hospital
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