Some very specific tenchnical qs on childbirth; any advice gratefully received...

[mrsbabookaloo]

Am 40+3 and hoping for a VBAC. Just started focusing properly on the birth. Thought I was quite well-read and well-informed but have got a template VBAC birth plan and it has raised some questions:

1. One of the things it says is "I request no internal scar check"....I didn't know they could check your scar internally. How do they do it? Why would I not want it done?

1. What are the pros and cons of stitching versus not stitching if you've torn?

1. What is "cord traction"

1. Is "syntometrine" the same as syntocin? (this is in the part that refers to managed versus physiological third stage)

1. If I have to have a c-section, what is the difference between a "spinal" and an epidural....I have googled this and am confused as to whether they are the same or different. If they are different, what are the pros and cons?

I realise I should have asked my midwife these qs at my appointments, but if anyone has time to answer any of them, I'd be very grateful.

Oh poo: typo in my thread title!

1. Don't know

1. You will need stitching for some tears, depending on how deep the tear goes. For 1st degree tears, it's simpler to let it heal without stitches though if you can.

1. Cord traction is pulling on the cord to get the placenta out - not advised, as I understand it, unless you've had the injection.

1. They go in different bits of the spine. Spinal tends to be a single injection, epidural tends to be an on-going or top-up-able infusion.

Thanks flamingobingo.

Any other answers, anyone?

1. I wonder if that means examining you to see if any internal tearing, in which case I would want it done, though that sort of thing doesnt bother me.

2. Depends on the size of the tear.

3. Pulling on the cord to help placenta out.

4. Both contain oxytocin, syntometrine also has ergometrine in it.

5. They go into different bits of the spine. Spinal gives more complete anaethesia, and is a single injection. Epidural may be less complete block, and can be topped up.

1 - dunno! Where did you read about it?

2 - stitching is helpfull if the tear gapes, lines up incorrectly, the tissue is bleeding heaviliy and so on. It isn't done routinely, each tear is taken on it's merits. Episiotomy will always be sutured, the sharp edge means they bleed and this needs controlling.

3 - if you have a managed 3rd stage, medically managed, the placenta is removed by the midwife or whoever delivers you. Controlled Cord Traction is a fancy was of saying pull onthe cord with continuing pressure rather than short yanks [although we may give little tugs to 'feel' if it has been released yet'. It you do not have medical management there is no need for this as the body and you gently push it out slowly.

4 - syntocinon is sythetic copy of oxcytocin, one of the hromones that make you contract.
Syntometrine has ergo added, this allows the uterus to contract and 'hold'. This is why it controls bleeding after delivery so well.
IF you choose to have medical managemnet of the 3rd stage, or if it is indicated for medical grounds.

5 - spinal and epidurals go into a different space in the spinal coloumn. By mm's, but it counts. The spinal is a faster acting, much much denser block. The epi is still fast but takes longer to wear off. It can alos be maintained at a level to sut you, so it is ideal for the unkown nature of the length of labour.

N.B. about 4, ergot is not helfull for those with raised bp, and can make you barf. Though women can be sick after delivery anyway. The sickness tends to wear off in 10-20 mins if its ergot causing it, people usually vomit a couple of times.

Thanks for these answers, which are v helpful.

The "internal scar check" is referring to my previous c-section scar. This reference is in an NCT template birth plan for VBAC, but midwives/VBAC consultant have never mentioned being able to check the scar internally: I thought the only way they could tell if the scar was rupturing was that the baby would become distressed, hence the need for continuous fetal monitoring.

My spinal vs epidural q was specifically for the purposes of another c-section, if my trial of labour doesn't work out. Are there pros and cons for spinal vs epidural for c-section?

If you are having a C Section (and dont already have an epidural in) I would want a Spinal. IMO for that you want a dense block, and not to be worried that you might be in pain. I have had an ineffective epidural and would not have been able to tolerate a CS under those conditions.

OK, thanks.

I think last time, they had just put an epidural in (I had refused for a long time and they had persuaded me) when dd's heartrate dropped and I had to go into theatre and IIRC, they switched the epidural for a spinal.

Wish I'd paid for a copy of my notes!!

Oh - maybe they mean a scan of the site? I think that can be done, but tbh if there is that degree on concern then Dr's will recommend delivery.

Unless they mean antenatally?

If you choose epidural for your trial, then should you go for section, the anaest. will top it up with different drugs to ensure your pain relief for the surgery. You shouldn't need your back 'fiddling' with again though. A small tube is inserted when the epi goes in, so drugs are put down that. It's taken out after delivery, whivh a midwife or health care assistant can do. No pain.

People who go straight to section usually have spinal as they are easier and quicker to do for a start. There are probably more medical reasons I am not expert in.

Thanks treedelivery: I really appreciate you taking the time to respond.

Oh blimey no problem!

mrsb, internal scar check is just that, an internal examination. I had one when I had ds2 but that was because of the pain I had between contractions from my previous cs scar. It's not really something you would want unless there was concern over your scar rupturing, it's not a comfortable experience. Hth

Sorry to hi-jack but is continual monitoring always necessary when having a VBAC?

That would really put me off trying.

I tore in all three births. The first two were fully stitched and healed perfectly.

The third was only partly stitched because it was a very minor tear, but six weeks on I still had redness, pain and stinging. So I would recommend being properly stitched for even a minor tear, as it will help it heal better.

One of my midwife had worked in Africa for years and seen many non-stitched tears, and she said she would never leave any tear unstitched.

I've had 3 vbac and each time have had a scan of the womb to check on the thickness of the muscle in the area. It helps to check if the scar will with stand the strain of labour. The scan was done as usual over my tum and took a few mins. Everything was ok. Best wishes xx

when researching for my vbac I read somewhere that the mother's pain is a better and faster indicator of rupture than fetal distress (which can be caused by any number of things, including just normal childbirth processes); it is one of the arguments against continuous or electronic fetal monitoring for vbacs.

I had a spinal for an em cs. Every other woman on my postnatal ward had an epidural for theirs. I was discharged after 12 hours as had regained sensation before I even left theatre. The other ladies that had CSs were still in bed 12 hours later and not up and moving.

Of course it's not as simple as that but on a busy PN ward I was able to care independently for dd without relying on the buzzer because I couldn't move to pick her up/change her.

Had a spinal block as soon I was was diagnosed with Shoulder Dystocia - immediate effect total block from boobs down over. After the birth (missing out gorey details) and the mammoth task of trying to sitch me back together, the block wore off within an hour (I think) and I could walk (like john wayne).

Sorry, can't answer your other questions.

xx

Thanks to all those who have contributed today: didn't realise thread was still going!

Bigcar; it must be uncomfortable, how do they get all the way up there? What with?

SarahL2: hospitals recommend continuous monitoring for VBAC so they can check for fetal distress which may be a sign of scar rupture (or not, as phdlife says), but you don't have to do it. I'm thinking of going along with it, but asking for breaks if I want more freedom to move.

Thanks for all the info on stitching...having not been through the actual giving birth part last time, this is the aspect I'm most nervous about.

mrsb, it's done by hand which I guess answers why it's so uncomfortable Hope it all goes well for you