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Who Needs a Caesarean Birth?

Who Needs a Caesarean Birth?. Max Brinsmead PhD FRANZCOG May 2008. Factors which influence the outcome of a trial of labour. The Passage The Passenger The Powers The Psyche. The Passages. Stature (and maybe shoe size!) Shape of the pelvis Gynecoid Android Anthropoid Platypelloid

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Who Needs a Caesarean Birth?

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  1. Who Needs a Caesarean Birth? Max Brinsmead PhD FRANZCOG May 2008

  2. Factors which influence the outcome of a trial of labour • The Passage • The Passenger • The Powers • The Psyche

  3. 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

  4. The Passenger • Size • Presentation • Position • Adversely affected by epidural anaesthesia • Attitude • Flexed or deflexed • Moulding • Does this change with gestation?

  5. 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

  6. 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?

  7. 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

  8. The Psyche • The place of birth • Maternal anxiety • Analgesia in labour • Preparation for birth • The role of a doula

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