Pregnancy Lounge

Tag: cesarean

  • Reasons for Cesareans

    There are many reasons for cesareans and they vary with the individual woman, as well as the individual pregnancy. The chance of needing a cesarean depends on how your pregnancy is progressing and what complications may arise as your due date draws near. Sometimes cesareans aren’t the only option and the reasoning is questionable, while other times there are legitimate medical reasons making a cesarean unavoidable. In some situations, cesareans can be life-saving for mothers and babies.

    Occasionally, an emergency arises when your baby may need to be delivered within a matter of minutes. An emergency cesarean may be caused from such things as: a prolapsed cord (when the umbilical cord comes through the cervix before the baby’s head, preventing blood flow and oxygen from reaching the baby), which occurs in close to 4% of births, placental abruption (when the placenta separates from the uterine wall before birth), placenta previa (when the placenta is low and covers the cervix either partially or completely) and uterine rupture (when the uterine tissue tears).

    Fetal distress is another cause for the need of a quick delivery leading to a cesarean. This happens when there are concerns about the baby’s health during labor. Changes in the baby’s heart rate (when it’s very fast, very slow or irregular) may signal a problem such as he or she is not responding ideally to contractions or is not getting enough oxygen, either because the umbilical cord is being compressed (pinched or wrapped around something) or the placenta isn’t functioning properly.

    If the baby is mal-positioned (not in a good position for vaginal birth), a cesarean may be recommended, although sometimes babies can be turned or can be delivered vaginally anyway. Some common positions include: transverse (lying sideways) and breech (feet or bottom first). Breech positions account for between 12- 15% of all cesareans.

    << click for the rest of the article on reasons for cesareans >>
    << Avoiding Cesareans >>

  • Cesarean – When is a Cesarean Delivery Necessary

    When pregnant women think about childbirth, they rarely envision having a c-section. Most assume they will deliver vaginally, although with the United States’ cesarean rate at an all-time high, the odds are good that you may, in fact, have a c-section. If you’ve had a previous cesarean, you are much more likely to have another, with a decline in vaginal birth rates following previous c-sections. A recent study found that 47% of moms who’ve had a previous c-section aren’t even considering a vaginal birth the next time. Also, pre-planned or “elective” c-sections are becoming more and more common, when many times there is no identifiable medical reason. Cesareans are the most common surgery performed and it’s believed that between 25- 50% are unnecessary. More below:

    If you live in the United States, there is about a one in four chance your baby will be delivered by cesarean, which is a very steep rise since 1970, when only 5% of all deliveries were by cesarean. In the late 1980s and early 1990s, there was an overall decline in the number of cesarean deliveries in the U.S.

    In the mid 1990s, the rates began to increase rapidly. From 1999 through 2001, the percent of “elective” c-sections grew from about 1.56% to 1.87%, which is a 20% rise. In 2002, cesarean deliveries increased by 67% among low-risk women. Low-risk, first-time moms who were 40 and older were more than five times more likely to have a c-section than first-time moms between the ages of 20 and 24. In 2002, the number of vaginal deliveries was less than 3 million, while the number of cesarean deliveries were about 1.1 million (approximately 634,000 were first time c-sections and 409,000 were repeat c-sections). Now the rate has jumped to well over 27% of all deliveries in the United States, which translates to about 27 c-sections for every 100 births. Some hospitals have a staggering cesarean rate of over 50%!

    Why the increasing cesarean rates? It is believed that the rates of c-sections among women in the United States are on the rise for a number of reasons including: increasing age of pregnant women, more underlying conditions such as diabetes and hypertension, for convenience purposes, fertility treatments yielding more twins and triplets, improved fetal monitoring (which has made it easier to tell if the baby is stressed), as well as liability reasons for doctors and hospitals, who may feel as if their risk of being sued is greater if complications occur during a vaginal delivery.

    << Reasons for Cesareans
    << Avoiding Cesareans

  • more Reasons for Cesareans

    Failure to progress, or “dystocia” accounts for close to 30% of all cesareans. When the cervix won’t dilate or if it slows down or stops altogether at some point and labor is taking longer than average, a cesarean may be suggested. Also, prolonged labor may be caused by the baby not descending or contractions that aren’t strong enough, even after an attempted augmentation with cervical ripening agents or Pitocin.

    If the baby’s head is too large to fit through the pelvis (which is often called cephalopelvic disproportion or “CPD”), either because the mother is too small or the baby is too big, a cesarean may be necessary. Sometimes a woman has a deformed pelvis because of a birth defect or a debilitating disease such as rickets or polio, which makes a vaginal delivery incredibly difficult or impossible.

    A cesarean may be necessary if certain maternal health conditions are present. Toxemia, high blood pressure, gestational diabetes (which can lead to an extra large-sized baby), pre-eclampsia, heart or pulmonary disease, HIV infection, obstruction of the birth canal by fibroids and active genital herpes lesions are all possible indicators that a cesarean may need to take place, but not in all situations. Maternal exhaustion accounts for a small number of cesareans.

    Problems with the baby such as genetic deformity, neural tube defects, hydrocephalus or heart problems can lead to a cesarean. Some babies may not survive the process of labor and vaginal birth. Also, multiple births run a higher risk of complications if a vaginal delivery is attempted. Cesareans are routinely performed with the delivery of twins, triplets (or more), since giving birth to multiples poses unique challenges. Multiples are much more common now, as a result of fertility treatments, which also contributes partially to the increase in the overall cesarean rates.

    Close to a third of all cesareans are repeat cesareans, although more and more women are electing to try VBAC (vaginal birth after cesarean). On the other hand, many hospitals and doctors are choosing not to offer VBACs any longer.

    The reason for the high number of repeat cesareans is partly because of the concern for a possible uterine rupture. Pre-planned or “elective” cesareans (for non-medical reasons) are becoming increasingly popular. The reason for this jump is mainly simply for convenience purposes (for the doctor, as well as the mother).

  • Avoiding a Cesarean

    A high percentage of cesareans done in the United States are medically unnecessary, therefore many are preventable. There are measures that can be taken to help possibly avoid an unnecessary cesarean. However, clearly there are times when cesareans are very necessary, such as instances of a prolapsed cord, placenta previa and uterine rupture, which would all lead to an emergency c-section to save the lives of the mother, baby or both.

    Become Cesarean Educated

    During your pregnancy, attend childbirth classes. This may allow you to talk with others who have been there and may also give you many great coping skills for labor to increase your comfort and decrease the need for medications and intervention. Read and learn as much as you can about the birth process, all of your birth options and what to expect during labor, which may help you to appropriately express your choices for birth to your doctor or midwife. When choosing a doctor or midwife, interview more than one and ask lots of questions, including what their philosophy is on cesarean birth. Ask them what their “primary cesarean rate” is in their practice. The number should preferably be no more than 10%. Ask them if there is a time limit for labor and the pushing stage and also ask what they feel can interfere with the normal labor process. If you’ve had a previous c-section, be sure to ask about the possibility of a VBAC (vaginal birth after cesarean).

    Delivery Options

    Once you choose a doctor or midwife, discussing your delivery wishes early on is extremely important. Preparing a flexible birth plan is also very helpful and important. After researching and creating a birth plan, make copies and give them to everyone who will be involved in your labor and delivery, including your labor support people, your doctor or midwife, as well as the hospital or birth facility. Discuss it extensively with your doctor or midwife and share your goal of avoiding a cesarean birth unless absolutely necessary.

    Choose a labor support person, such as a doula (an experienced labor companion who provides continuous emotion support and information during labor and delivery) . Cesarean rates for women who choose professional labor support are significantly lower. Professional doulas are trained in the ways of labor support using massage, relaxation (including aromatherapy), coping techniques and physical comfort measures.

    Labor Induction

    If possible, try to avoid an induction of labor, which can lead to an increased risk of needing a cesarean. For a labor that is progressing slowly, try other things such as nipple stimulation instead of Pitocin for augmentation. Explore your pain relief options. Epidurals and other anesthesia can slow down labor progression (especially if done too early during labor). With the use of an epidural, you cannot walk, therefore you can’t use gravity to help labor along and also because of the numbness, you may have trouble pushing effectively. If you feel the need for an epidural, wait until you are past 5 centimeters, if possible, and in active labor.