Question

Chapter 21: Nursing Management of Labor and Birth at Risk

1. Laura is a 26-year-old G2P1 who had a caesarean delivery for fetal distress with her first pregnancy. Laura is now struggling with deciding between a repeat caesarean delivery or attempting a VBAC. (Learning Objective 9)

A.    In order to ensure that Laura has the facts to assist her in her decision, explain the risks of a repeat caesarean delivery.

B.    Laura can’t understand why more women don’t want to try a VBAC delivery. Discuss the possible reasons for this.

C.    Describe the management of care for a woman attempting a VBAC delivery.

Answer 1

A . Risks of a repeat caesarian delivery are

- Heavy bleeding

- Bowel and bladder inuries : The risk is due to bands of scar like tissue developed after a previous C- section binding the bladder to the utreus. Postoperative adhesions can also cause small bowel obstruction.

- Problems with placenta : Placenta implanting too deeply into the uterine wall or the placenta partially or completley covering the opening of the cervix.

B. Some risks of a VBAC are

Infection

Blood loss

Risk of rupture of the uterus , it may harm both mother and foetus.

C. Should deliver in a hospital settings with facilities for neonatal resuscitation and caesarian section.

Avoid induction of labour . The risk of uterine rupure is less with mechanical techniques.

After 39 weeks an elective C-section is recommended.

Continuous CTG (cardiotocography ) monitoring is to monitor fetal heartbeat and uterine contractions .