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Re: c/s vs TOL From: KatMertz@aol.com Tue Aug 31 21:44:26 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Previous message: Ricardo Savaris: "Re: New Case" In a message dated 8/31/99 7:19:52 PM Eastern Daylight Time, ob-gyn-l@obgyn.net writes: > Dear Remaining Listers, > > I had an interesting case this afternoon . A 35 yo G2P1 from Pakistan walked > into > my office wanting a Silent Delivery and vaginal birth . She said she is > really > healthy and had no problems with her first pregnancy but that in Pakistan C/ > S is > used as population control because women aren't allowed to have more than 4 > C/S. > She then showed me her vertical scarred uterus . I asked why the C/S was > done and > she said they told her she has a contracted pelvis. I examined her- She > doesn't > but she does have a narrow arch . I asked why a vaginal was so important to > her . > It seems she was awake and aware but unable to move or speak during th > surgery . > She also felt the surgery ! This lady is intelligent and college educated . > But > after her experiences she says she doesnt intend to return to a hospital . > She is > a more than lousy candidate for out of the hospital birth . And she has a > pelvis > that it would take lots of labor to push a baby through it . I offered to go > to > the hospital with her. Any good ideas comments or words of encouragement > for this > lady? > Tonya Brooks > I believe a patient with an unknown scar, perhaps vertical has a 10% chance of uterine rupture with TOL. This lady should be informed of the risk/benefits. Many women whatever the scar may choose TOL, and it is safe if done in a hospital where an emergency C/S etc is readibly available. You might try and find a CNM to deliver her in a hospital with immediate c/s back up available. The best of both worlds is avialable in most communities. Katria Mertz CNM Previous message: Ricardo Savaris: "Re: New Case"

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