While OB clinicals are certainly exasperating, I am learning a lot (about
the medical model of care...)

Last week, I cared for a woman who had just had baby #6 by cesarean. So, it
does happen, at least around here, that a woman can have more than 3
cesarean births.

Knowing about the "new method" (single layer closure) of uterine closure, I
wonder about the difference in amount of muscle removed. Each time there is
another cesarean, the old scar is removed and a new one created. Is there
any sizeable difference between the amount of tissue used as comparing the
multiple layer closure and the single layer closure? I don't know if that
would make a difference or not, but most OBs around here are using the
single layer closure which is faster than the multiple. There is increased
risk of placental accreta (placenta growing through the old incision) with
single layer closure, but I don't know about amount of scar created or
tissue removed through additional surgery.

I was told today in class that a previous scar can open up, and a baby's arm
or leg can extend into the abdominal cavity of the mother, that the
instructor had seen this and wondered how many students had experienced this
during clinicals (none had). I wondered how a body part could extend through
an opening without the amniotic bag rupturing and the contents entering the
abdomen.

I was also told that in 24 hours, a newborn needed 30ml per pound of weight
(wonder why everything else is ml/kg, and this is ml/pound?). I questioned
this, as she had mentioned that a newborn's stomach was the size of a marble
(5-10ml). "If you have a 10# baby, that means she needs 300 ml of fluid in
the 1st 24 hours?" Yes, that's right. "But if we feed 10x/24 hours, that's
30ml/feeding? That seems like a lot!" Well, you divide it out for 24 hours,
and it's "only" an ounce per feeding. "But, if the stomach capacity is only
5-10 ml?" At this, she gave me "the look" and I shut up. 

Best wishes,
Sam

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