Sorry that I have been away from the forum for a few days due to personal and health reasons. It is always a horror hearing about the rare and tragic event of a maternal death in these modern times. Thank God that I have never seen a maternal death, and remember only two instances in the two hospitals that I worked in for the last 20 years as a midwife. There were never any maternal deaths in a planned homebirth in Israel (and I think none even in unplanned, unattended homebirths in Israel). A uterine rupture is extremely rare in a spontaneous and normal and non-obstructed labor. I havae been told by doctors that there is no case of a first birth, normal, spontaneous birth with a uterine rupture. The ruptures occur more with post-Cesareans, due to the weakened scar expecially if induced or accelerated with pitocin or prostaglandins. It is more likely to happen the more the pregnancy number is higher, and of course if a birth is obstructed, like with a shoulder presentation (transverse lie) or a head too big for the pelvis in a situation where there is no option for Cesarian. This is like a third world situation, and not a reality in Israel. However, it is a fact that one of the dangers of labor acceleration or induction is rupture, although very rare, and if too much is given or the women is not being observed properly. That is why ziruz should always be used with extreme caution, with a monitor and midwife in close attendence. Regarding epidurals, there is a big controversy. Some say that because the epidural anesthesia masks the syptoms of extreme pain (also in between contractions and in a specific spot), there is an added risk when there is an epidural. However, others argue that the pain of preceding uterine rupture is so severe, that it is felt with the epidural in a specific spot. This means that when a woman who had an effective epidural and felt no pain, suddenly complains of constant specific pain, especially if there is Pitocin, fetal distress, bleeding, blood pressure drop, this is a clear sign of impending rupture. Who is right? I say....drop the rates of speeding up labor, drop the rates of epidurals, drop the rates of unecessary Cesarians, have one midwife for every laboring woman, and we will probably never have to read again about a uterine rupture.
|
תוכן התגובה:
|