Re: Herniated Intervertebral Disk and Childbirth
From: art fougner, md (evsono@pipeline.com)
Fri Oct 22 09:56:41 1999
i doubt a woman with lumbar disk disease would be a candidate for lumbar
epidural analgesia/anesthesia.
Art
At Fri, 22 Oct 1999, Kathi Wilson, BHSc, RM wrote:
>
>I'm caring for a woman, G84314 (to my recollection, her GTPAL is
>complicated by the fact that she *insists* that an apparently miscarried
>twin be accounted for in her records).
>Hx includes 5 uncomplicated SVD's, the last at home. 1 loss (the
>preterm) due to trisomy 18. Devout Roman Catholic, and has a blossoming
>obsessive compulsive disorder.
>
>Since her last pregnancy, during which I cared for her, she has
>developed a fairly severe herniation of the intervertebral disk at
>L5/S1, which is now causing her to have pain with effort for bowel
>movements. She also has sciatic pain and parathesia in one toe. No
>urinary retention or fecal incontinence.
>
>Had a long tortuous conversation with her yesterday (her thought
>processes are pretty interesting to sort through). Her family doc (with
>whom I have conversed)had thought that her major issue was pain with
>pushing; however, it appears that this woman's major concern (about
>which she is now obsessing) is that she will become paralyzed during the
>birth with pushing. I have pointed out to the woman that, being as
>she'd had several babies, she would probably not have to push at all,
>and the baby would still be born. I have suggested that she consider a
>hospital birth and be consulted w/ anaesthesia regarding the possibility
>of using epidural analgesia (although she says she doesn't want that,
>either). I think what she wants is someone to predict the likelihood of
>damage leading to paralysis during the labour process. Intuitively, I
>would think that damage could just as easily happen if she has a big old
>sneezing attack during pregnancy (although I'm not about to tell her
>that right now).
>
>Anyway, I'd be interested in any and all experiences you all have with
>dealing with women w/ lumbar disk disease during pregnancy and birth.
>I'm going to see if I can talk her into getting back into physiotherapy,
>and also perhaps send her to OT as well. Her family doc is also well
>apprised of what's happening. Any other suggestions?
>
>(Other than Valium for me...she nearly drove me to drink the last
>pregnancy. And she told me her last app't w/ me that she's not done
>having kids yet, even tho' she apparently has a dispensation to use
>birth control.)
>
>--
>Kathi Wilson BHSc RM
>Thames Valley Midwives
>London, Ontario, Canada
>http://tvm.on.ca
>mailto:wilsonk@gtn.net
>
--
"Of course, that's just my opinion. I could be wrong."
-----Dennis Miller
art fougner, md
SonoScan/Genetic Sciences
forest hills, ny
evsono@pipeline.com
|
|
