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VBAC Cubby - vaginal birth after cesarean

VBAC and Epidurals
by William Reid Camann, MD
Dr. CamannQ. Does an epidural mask signs of uterine rupture in a woman undergoing a trial of labor for a vaginal birth after cesarean?

A. The short answer is no! The typical signs of uterine rupture during labor are pain and changes in the fetal heart rate pattern. With regard to pain, the sensations experienced by someone who has had a uterine rupture include severe abdominal pain, often sensed all over the abdomen. The typical epidural anesthetic used during labor nowadays is a very light block, just enough to blunt the labor pain, but still allow some sensations and ability to feel mild aches or pressure with contractions. The pain of a uterine rupture will almost always still be able to be felt even if you have an epidural anesthetic during labor. In addition, a severe uterine rupture is often accompanied by changes in the pattern of the baby's heart rate. As almost all patients attempting VBAC will have continuous fetal monitoring, these changes will be noted, even in the absence of any pain.

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