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- Cesareans...Information and Risks

Last Updated: 9/24/2011

Rise in cesareans-  Nearly one of every three births in 2009 32.9% was a C-section, according to the CDC.  This reflects the 13th consecutive year of increase.  Since 1996, the cesarean rate has soared a whopping 56%, according to the Annual Summary of Vital Statistics: 2008, a report from the National Center for Health Statistics and the Johns Hopkins Bloomberg School of Public Health.   

                     

 Ways to avoid them-

Seek providers with low cesarean rates (15% or less) and those that support VBAC

Stay healthy with good nutrition and lifestyle habits

Chiropractic care (encourages good baby positioning)

Be informed 

Allow labor to begin on its own

Avoid common interventions: epidurals, pitocin, or AROM

Hire a doula or have a homebirth

Valid indications-

Prolapsed cord (cord comes before the baby)

Placenta abruptio (placenta separates before birth)

Placenta previa (placenta partially or completely covers the cervix)

Fetal malpresentations (transverse lie, breech or asynclitic position-although some breech and asynclitic babies can be born vaginally)

CPD (highly over diagnosed, can be caused by maternal or fetal positioning)

Maternal medical conditions (active herpes lesion, severe hypertension, diabetes)

Fetal distress- (controversial as to how this conclusion is come to, ie: continuous EFM does not improve maternal or neonatal outcomes)

Increased dangers for mother and baby-  - The evidence shows that cesareans place women and babies at increased risk for morbidity and mortality both immediately following the birth and in the long term. 

For Mother

Accidental surgical cuts to internal organs

Major infection

Emergency hysterectomy (uncontrollable bleeding)

Complications from anesthesia

DVT, PE, stroke

Difficulty forming attachment

Less likely to have their infants skin-to-skin

More likely to have more blood loss and longer recovery time

Possible adhesions (thick scarring) which may cause chronic pain lasting years

Risk of uterine scar rupture in future pregnancies

Voluntary or involuntary infertility

Future ectopic pregnancy 

Placenta previa, abruption, or accreta in future pregnancies

Baby with congenital malformation or CNS injury due to poorly functioning placenta

Stillbirth in future pregnancy

For Baby

Accidental surgical cuts, sometimes requiring suturing

Baby born preterm as result of scheduled surgery

Complications from prematurity: respiration, digestion, liver function, jaundice, dehydration, infection, feeding & regulating blood sugar levels and body temp

Childhood development of asthma

Death in first 28 days after birth

Less interaction with mother, less likely to be breastfed early and well, and longer

What to expect if one is necessary-  If an elective cesarean is necessary, then you should be able to request that you begin labor naturally before the cesarean is done. Following are several preparation procedures that are done before you enter the operating room: establishing an IV, giving a bolus of IV fluid, placing the epidural catheter, ensuring adequate anesthesia, inserting a urinary catheter, checking of vitals (blood pressure, heart rate, temperature), and checking fetal heart tones. There should be no reason why you cannot have your support person/team there to comfort and support you during any of them.  Inserting the urinary catheter can be especially uncomfortable and many mothers recommend delaying the insertion until after the epidural is in place.  

There are three options for anesthetic during a cesarean section, general anesthesia, epidural anesthesia and intrathecal anesthesia (with both of the latter, mom is awake for the delivery). 

Routinely, your hands are strapped down to prevent tangling of the various cords to the medical equipment that is monitoring you and to prevent your arms from falling off the narrow boards they are placed on. You can ask to not have your hands strapped down so as to better receive your baby when s/he is brought to you.  If you and your partner would like to view the actual birth then make sure your physician realizes this. Explain that you would like the option of viewing the birth, either by lowering the screen or by positioning a mirror. 

Request that the baby be placed on your chest with a warm blanket over you both. If you want your placenta, be sure that the staff knows.  It belongs to your baby, not the hospital, and you do not have to give a reason.  You can request that the cord not be cut until you are ready when you leave the recovery room.  You may have to make sure they realize the importance of this in the event that the cesarean is an emergency and you are put under general anesthetic. If that is the case, you can have your baby given to your partner as soon as possible after birth and held by him (hopefully skin-to-skin inside his shirt/scrubs) until you are in the recovery room.

Finally for closure of the incision there are two methods double suturing method (suturing of both the inner wall and outer layer of the uterus) or single layer.  Double suturing will further ensure scar integrity for subsequent pregnancies and labors. Closure of the skin layer can be done either with staples or with sutures. Be sure to make your physician aware of your preference if you have one.

 

Knowing which reasons are absolutely necessary and which are preventable requires some knowledge and preparation in order to make a decision that fits best your desires for you and your baby.

                     

Sources:

  • http://www.motherfriendly.org/pdf/TheRisksofCesareanSectionFebruary2010.pdf
  • http://healthland.time.com/2010/12/20/c-sections-on-the-rise-especially-for-black-moms/#ixzz1FMtcQBvB
  • http://ican-online.org/news/cesarean-rate-jumps-again-record-high
  • http://ican-online.org/ican-white-papers
  • ICAN, Birth Class:  Cesarean Prevention

 


 

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