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This is a case report of a 39-year-old multigravida woman without allopathic prenatal care who, after three previous caesarean sections, attempted to deliver her fourth child at home with the help of a direct entry midwife. During labour, fetal movement and fetal heart tones became undetectable, at which time the patient was referred by the midwife to the hospital. The patient was diagnosed with uterine rupture, bladder rupture and fetal demise; she was rushed to emergency surgery. The patient's lack of allopathic prenatal care, attempt of vaginal birth after three previous caesarean sections, coupled with her desire for delivery at home, led to her complicated course. The patient related that she was never made aware that attempting a home birth after three prior caesarean sections put her at increased risk for complications, and she was also unaware that midwives could have varying levels of training.

the first chair of the Section on Anesthesia at the Mayo Clinic, had an idea that profoundly affected not only the field of anesthesia but also the rest of medical training at the Mayo Clinic. In 1925, Lundy proposed establishing an institution-sponsored anatomy laboratory.At that time, the Section on Anesthesia was still in its infancy, with anesthesia services split between Worral, Saint Marys, Kahler, and Colonial hospitals. 1 These hospitals combined had 20 operating rooms and 1 obstetrical suite. Two physician anesthesia providers, 21 anesthetists, and 3 assistants 1,2 provided anesthesia for more than 20,000 patients who underwent surgery at the Mayo Clinic in 1925. 1 Besides managing these responsibilities, Lundy trained several surgical fellows each year in the art of regional anesthesia. 2,3 Lundy noticed that the surgical fellows' interests did not lie in learning anesthetic techniques, but he believed that anesthesia should be delivered only by those trained in the specialty. Lundy, searching for a way to interest surgical fellows in the emerging field of anesthesiology, to entice more physicians into becoming dedicated anesthesia providers, and to develop a resource for anesthesia education, approached Mayo Foundation for authorization to establish an anatomy laboratory. 4 He predicted that the laboratory would be a great success and would serve as one of his most valuable assets for training anesthesia fellows. William J. Mayo gave his approval (Figure 1), and Lundy began work on the anatomy laboratory in 1925; however, no meaningful work occurred for almost 13 months. 5,6 During this intervening period, Lundy solved several logistical problems. First he had to procure and furnish a room that would serve as the laboratory. 6,7 He accomplished this with Mayo Foundation assistance and with tools and instruments sometimes borrowed from operating rooms. 5,7 His next dilemma was how to prepare, store, and lay to rest the cadavers. He contacted the University of Minnesota and Stanford University anatomy departments