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20/6/2005 22:51
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Ilana Shemesh, natural midwife
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מאת:
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uterine scar rupture
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כותרת:
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You need to know that uterine rupture of a scar is less than 0.5% Especially since three years have passed, your scar should be strong enough. Research shows that it is best to wait 24 months between children for the scar to get strong. During the 17 years that I worked in hospitals, Assuta and Misgav Ledach, we had many women birthing vaginally after a Cesarean. I don't remember even one case of a scar tearing, although I know that two midwife friends of mine did see this VERY RARE happening. Signs to indicate a uterine scar tearing would be the stopping of all pain, bleeding, and a severe drop in the heartbeat. If you have a midwife listening frequently to the heartbeat,I don't think you need to be on the monitor all the time. Certainly you can ask to be on and off. Better not to have any epidural either, since the pain is a good indicator that there is a problem, if suddenly all the pain stops. Feeling pain above the scar is not a reliable symptom since most women feel labor pain just where the scar is, in the lower abdomen above the hairline. If you feel constant pain there when there is not contraction, this is not a good sign either. Also the use of oxytocin or prostaglandin to induce or speed up a labor will increase greatly the chances of uterine scar tearing. The big question in my mind is just how accurate this ultrasound evaluation of your scar is. After all, we know how many mistakes the ultrasound makes in assessing fetal weight and size. I would go to another specialist for an opinion about the scar, but don't tell him what the other doctor said. See if he comes up with it on his own. Remember to put things in proportion. Although there is a 0.5% risk of your scar tearing, another Cesarean raises your risks of complications postoperativly with infection and bleeding, and now there is research connecting future stillbirths with Cesareans. Also babies have more respirattory problems after Cesareans. Being on a monitor all the time will make your labor slow down, be very hard to deal with without an epidural, and increase your chances of having another Cesarean.
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