Mary’s 1st baby was delivered via c/section due to the baby being in the breech position. She is requesting a VBAC (vaginal birth after c/section) for this her second baby.

Mary’s 1st baby was delivered via c/section due to the baby being in the breech position. She is requesting a VBAC (vaginal birth after c/section) for this her second baby. By ultrasound this baby is in the vertex position. In reviewing the postoperative report from her first surgery – it is noted that she had a low transverse uterine incision.

What are your thoughts on having a vaginal birth with this second baby?

What education can you provide to her?

What is the risk to her and does this change your thoughts and advise?

Group B Response

Mary is not progressing in labor appropriately, and the decision has been made to move toward a cesarean section. She understands, agrees, and signs the consent for surgery. You will again accept this patient in the recovery – or initial postpartum period.

Recognize that you will complete BUBBLEHE assessment. In addition, the abdominal assessment will also include assessment of the incision. Note the type of dressing used to cover the incision. Is it approximated? Is there any bleeding? Does she have bowel sounds? Is the abdomen distended? Is it soft? Do you assess the fundus and where is it located? It should be firm. Note pain assessment.

Discussion Group B will provide initial post to the following questions, and respond to Group A.

Discussion Group B:

Postpartum:

Susan P. had a SVD (spontaneous vaginal delivery) today approximately 2 hours ago. The labor and delivery nurse is calling to give you report. She is new and not sure what you want to know from her.

What questions do you need to ask to provide comprehensive care to this patient once she is transferred into your care?

Discussion

Note that you discover that Susan is Rh negative, her baby is Rh positive. What now?

Please discuss Rhogam. The drug, the need, the route, the risk.

When must you give this and under what circumstances will you give this injection?

Please also recall any other reason Rhogam would be given, and when.