Who Needs a Caesarean Birth?
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Transcript of Who Needs a Caesarean Birth?
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Who Needs a Caesarean Birth?
Max Brinsmead MB BSMay 2015
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Factors which influence the outcome of a trial of labour
The Passage
The Passenger
The Powers
The Psyche
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The Passages
Stature (and maybe shoe size!) Shape of the pelvis
Gynecoid Android Anthropoid Platypelloid
Pelvic joint changes and position in labour Soft tissues
An effect from parity
Maternal obesity
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The Passenger
Size Presentation Position
Adversely affected by epidural anaesthesia
Attitude Flexed or deflexed
Moulding Does this change with gestation?
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Estimating Birth Size
Notoriously inaccurate: Ultrasound measures abdominal circumference
typically +/- 20% That is 2880 – 4320 g for average 3.6 Kg baby
Need to consider: BW of previous babies Mother’s size and weight gained in pregnancy Mother’s own birthweight Ethnicity Father’s size
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Estimating Pelvic Size
Clinical pelvimetry Unreliable
X-ray or CT pelvimetry Abandoned
“The best pelvimeter is the baby” Engagement of the head before labour Engagement and descent in labour “Trial of labour”
Pelvic soft tissues are more important?
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The Powers
The effect of parity Maternal age An effect from posture
Upright position in labour Fetal back uppermost when lying
Induction of labour Augmentation of labour
Amniotomy Oxytocin infusion
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The Psyche
The place of birth Maternal anxiety Analgesia in labour Preparation for birth The role of a doula
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