Epidural analgesia for a vaginal birth after caesarean section: Acase report

Abstract

The use of epidural for vagina birth after caesarean section is contentious even in established Labour and Delivery Units because of concerns regarding maternal and fetal wellbeing following the occurrence of a uterine rupture as epidural analgesia may obscure the pain following such. Epidural analgesia has remained the major option for the management of pain in labour. Recently, there has been anecdotal evidence of increase in the use of epidural in labour and consequently brought to the fore a wide variety of case-mix on the floor. We report a case of labour epidural analgesia for vaginal birth after caesarean section (VBAC). The Parturient was a 28 year old booked G2P1+0, gestational age 37weeks in latent phase of labour. She had a previous caesarean section done for fetal distress and a lower uterine incision was used for the delivery of the fetus.
Epidural analgesia was requested by the parturient and this was established in the sitting position using a size 18g Tuohy needle observing unit protocol. It was then activated with 8ml of 0.125% plain bupivacaine and then 5ml after 2 minutes. We ensured safety by ensuring close monitoring of the fetus using a cardiotocography and also of the parturient using a multiparameter monitor. At 4hours 40 minutes after admission, she had an unassisted vaginal delivery of a live 2.75kg male neonate with an Apgar score of 8 in 1 minute and 9 in 5. Baby was healthy and normal and the third stage of labour was managed using 10 international units of intravenous oxytocin and 20IU oxytocin in intravenous fluid 5% dextrose water.
Conclusion: Women for VBAC should not be denied epidural labour analgesia. Monitoring gadgets and recruiting more manpower should be advocated especially in emerging Labour and Delivery Units and engender resource-constrained environment.