Question

Questions:

1. Why was it so difficult for Esparanza to find an obstetrician who would consider doing a VBAC? Discuss the ethical dilemmas that exist when the de sires and needs of the client come in conflict with those of the practitioner.

2. What are the routine labs for this visit, and why are they done at this time?

3. Compare and contrast VBAC and repeat ce sarean section for the following : safety for both mother and baby, cost, pain; long-term effects, ef fects on breastfeeding , and parenting .

4. Her obstetrician asks for her previous cesarean section records before he will even consider a VBAC . Why ?

5. Why are cesarean sections usually done for breech presentation?

6. When would a vaginal delivery be considered for breech presentation ?

7. How can the baby be encouraged to move to a cephalic presentation?

Part 1 . PRENATAL CASE STUDIES Client Profile Esparanza is a 25-yearold, G2P1001, MHF at 36 wga. She had a previous ce sarean section with an epidural in Mexico six years ago for a breech presentation at 38 weeks gestational age. The baby weighed six pounds. She is five feet two inches tall, and her PPW was 100 pounds. She would like a vaginal birth after cesarean sec- tion (VBAC) with this pregnancy, however she saw six doctors before she found one who would even consider doing a VBAC. Case Study Esparanza seems anxious at today's prenatal visit. She tells the nurse that the baby feels like his head is up under her ribs and she fears another cesarean section for breech. The following data is obtained at this visit: Wt 125 lb FHT 140s URQ Fundal height (FH) 35 cm Fetal movement +(FM) Urine chemstrip testing: all negative No HA, vision changes No CVAT No edema

Answer 1

Ans1.as we know there is higher chances of uterus rupture in VBAC and in this case breech presentation also amplified the possibility of uterine rupture so the patient find difficult to got a doctor that done VBAC

There is social deligma that c section delivery are always bad but for a doctor that is not true it is a alternative method of delivery when there is normal vaginal delivery not possible so In that scenario there is conflict between patient and doctorsm

Ans2

USG- to find presentation of baby

CBC-To know about haemoglobin amount of mother

Blood type - to find RH status

Urine analysis - to rule out glucouria and preaclemcia

Urine culture

HepB and HepC tests

Ans4.

Becuse to find out the type of previous c section

There are 2 types of c section

1)vertical incision c sections

2) classical c section

There is always very high risk of complications to do VBAC in case of vertical incision c section

Ans5.

Becuse there is high chance of obstructed Labour like shoulder dystocia, cord prolapse in breech vaginal delivery.

Ans6

When the baby in Frank breech type of presentation.

Ans7

By doing ETERNAL CEPHALIC VERSION after 36 week of gestation