Pregnancy Lounge

Tag: labor

  • Preterm Causes

    Preterm Causes

    What triggers normal, full-term labor is not yet fully understood, so the actual cause of preterm labor is not completely understood. In over half of preterm labors, the cause is unknown. However, there are some factors which are known to increase a woman’s risk of experiencing preterm labor.

    Many preterm births (30-40%) are the result of preterm premature rupture of the membranes (PPROM), in which the amniotic sac that holds the baby breaks too soon, leading to preterm labor. Preterm labor usually begins shortly after PPROM occurs. Sometimes, when a slow leak is present and infection has not developed, contractions may not start for a few days. On occasion, a leak high up in the amniotic sac may reseal itself so that preterm labor does not start or subsides.

    A mother’s age may play a role in preterm labor. Women in their teens or women over 35 are at an increased risk. Also, some recent studies have found a link between severe stress and stressful life situations (including things like: domestic violence or death of a close family member) and preterm labor, as well as standing for long periods of time or extremely tiring jobs.

    Infections can cause preterm labor, including certain sexually transmitted diseases (STDs) such as: gonorrhea, syphilis, chronic active hepatitis, trichomoniasis and chlamydia, as well as any illness with a fever. Severe urinary tract infections (UTI), undetected or untreated, Group B Strep and bacterial vaginosis (BV) are also possible triggers of labor before term. Other conditions that may be related to preterm labor include certain chronic maternal illnesses such as: diabetes, high blood pressure, kidney disease/infection and sickle cell anemia.

    Illegal or non-prescription drug abuse (especially cocaine), cigarette smoking, alcohol consumption are all risk factors for delivering a preterm baby. Not gaining enough weight during pregnancy, having a pre-pregnancy weight of less than 100 pounds, and inadequate nutrition and prenatal care may cause preterm labor and delivery of a premature infant.

    A multiple pregnancy (expecting twins, triplets or more) puts you at a much higher risk for preterm labor. The increased size of the mother plays a role in the increased risk. Women who’ve had a previous preterm labor or premature baby, 3 or more first-trimester miscarriages or 1 second-trimester miscarriage are considered at a higher risk as well.

    Cervical trauma is a major cause for preterm birth, the most common being from cervical injury due to elective abortions. Women with a history of multiple first-trimester abortions or one or more second-trimester abortions are at a considerably increased risk of delivering before term. Uterine defects due to an incompetent cervix, uterine fibroids, excesses amniotic fluid (making the uterus extra large), previous cervical cone biopsy surgery, placenta previa and diethylstilbestrol (DES) exposure can lead to preterm labor, as well as a pregnancy that occurred while using an IUD (contraceptive device).

    Back to Labor Stages

  • Preterm Labor and Complications

    Preterm Labor and Complications

    asthma-pregnancy1-163x140Prematurity is the most common cause of sickness and death among newborns. Babies born before the 37th week of pregnancy are often called preterm or “premature”, babies born before the 32nd week are considered very premature, babies born before the 28th week are considered extremely premature. Generally, babies born after the 25th week of pregnancy have a survival rate of between 50-60% (although they will stay an extended period of time in intensive care), which increases dramatically to over 90% after the 28th week.

    Premature Babies

    Babies born earlier at the 22nd week of pregnancy have less than a 2% chance of survival, while babies born before the 20th week are said to be miscarried and cannot survive outside the womb, even with our improved medical technology. The more mature babies are at birth, the more likely they are to survive and the less likely they are to have health problems. In addition to age, the baby’s size tends to influence how well he or she does; larger babies generally do better.

    Many times, babies born preterm face weeks and sometimes even months in the neonatal intensive care unit (NICU), depending on their gestational age, size and overall medical condition. Usually, premature babies are too sick and too small to go home until close to their original estimated due date.

    Preterm Health Problems

    Preterm babies are at risk for a variety of health problems, serious complications and even death. Some have lasting disabilities (depending on their degree of prematurity) such as cerebral palsy, mental retardation, reading and learning problems (or developmental delay), chronic lung disease and blindness or deafness.

    Other babies, usually those born closer to term, have no long-term problems and grow up completely healthy. Sometimes, babies born closer to term (34-36 weeks) still have certain complications, as well as suffer 2-3 times the infant mortality rate during the first year as full-term babies. Mortality rates during the first year for babies 32-33 weeks are 6 times higher than those born full-term.

    Preterm Labor Treatment

    Babies born before 34 weeks often need to be on a ventilator (and may need a medication called surfactant) to help them breathe, because of respiratory problems. A common condition for these preterm babies is called respiratory distress syndrome (or hyaline membrane disease), which is a serious breathing problem caused by immature lungs, making it difficult or impossible for their air sacs to stay open, due to the lack of surfactant in the lungs.

    Apnea is also common, especially in babies born before 30 weeks. Apnea causes babies to stop breathing for short periods of time, due to their immature respiratory and nervous systems. Intraventricular hemorrhage (IVH) sometimes happens in the first few days of life and is quite common in very premature babies. This condition is when bleeding in the brain occurs, which can potentially cause seizures and brain damage.

    Certain blood and metabolic problems may occur in babies born before term. Anemia (low blood counts), which may require a blood transfusion is not uncommon.

    Early babies may develop jaundice, due to their livers being too immature to normally process bilirubin, which may turn them yellow or orange in color. Cardiovascular conditions may occur, such as patent ductus arteriosus (PDA), which is a heart condition that causes blood to divert away from the lungs. With this, a blood vessel near the heart (that normally closes after delivery) stays open and may need to be closed with surgery, if medication doesn’t work.

    Feeding difficulties are common for preterm babies, since many are unable to suck, due to undeveloped suck and swallow reflexes. Often, they require tube feedings, in which a tube is placed in the mouth or nose that goes down into the stomach. You can still pump your breast milk for your baby, which is ideally the best for your tiny little one. Preterm babies typically are cared for under special heaters or in enclosed incubators that help maintain a stable body temperature, due to temperature instability from low body fat and thin skin.

    Back to Labor Stages

  • Preterm Labor

    Labor that begins anytime before the 37th week of pregnancy is preterm labor (or “premature labor”). Ideally, pregnancies (under normal circumstances), last for approximately 40 weeks from the first day of the last menstrual period, give or take 2 weeks. Most babies are considered “full-term” if they are born after the 37th week of pregnancy. If you have contractions sufficient enough in strength and frequency to start to efface (thin out) and dilate (open up) your cervix or if your water breaks (preterm premature rupture of the membranes or “PPROM”) between 20-37 weeks along, you’d be considered in preterm labor.

    It is estimated that as many as 10-12% of pregnant women in the U.S. will suffer from preterm labor, not including twin or triplet pregnancies. Approximately 60% of twins and about 90% of triplets are born preterm. Overall, the rate of preterm births are rising, mainly due to the large numbers of multiple births in recent years. Twins and other multiples are six times more likely to be preterm than single birth babies. The rate of premature single births is slightly increasing each year. Between 1992 and 2002, the rate of babies born before 37 weeks increased almost 13%. In 2002, there were over 480,000 preterm births (about 1 in 9 live births). The preterm birth rate was highest for black babies (over 17%), followed by Native American babies (almost 13%), Hispanic babies (over 11%), Caucasian babies (over 10%) and lowest for Asian babies (over 9%).

    Early detection of preterm labor is very important, so steps can be taken to stop labor from progressing and to prevent preterm delivery. Being informed and aware of early warnings signs can make all the difference. The early signs of labor can be subtle and hard to detect; some women experience preterm labor without noticing any uterine contractions at all. Don”t hesitate to call your doctor or midwife immediately if you think you are experiencing any symptoms of labor and you are less than 37 weeks along. Always call if you have any reason to suspect you might have preterm labor or you are confused or concerned about what you are feeling. Some symptoms can be especially confusing, because they may occur normally as typical pregnancy discomforts (including pelvic pressure and lower backache).

    Symptoms of preterm labor that you want to watch for include: uterine contractions that are fairly regular (whether they are painless or not) that occur 4 times or more within an hour and abdominal menstrual-like cramping (constant or occasional), with or without diarrhea. It may be difficult to tell the difference between Braxton-Hicks (or “practice”) contractions and the real thing. Monitor your contractions, by timing them (from beginning of one to the beginning of the next) and writing down your results. More than 4 in an hour, especially accompanied by other symptoms definitely warrants a call to your doctor or midwife, to be on the safe side. Other common preterm labor symptoms include: persistent, lower back pain (especially if you don’t typically have back pain), sudden increase in vaginal discharge (particularly gushes or a trickle of watery, mucus-like or blood-tinged fluid), any vaginal bleeding or spotting (some spotting is common after pelvic exams), persistent and/or increased pelvic pressure (painless or not) and frequent diarrhea.

    Back to Labor Stages

  • Preterm Labor Treatment

    Depending on how far along you are in your pregnancy, your doctor or midwife may not attempt to stop your preterm labor. If you aren’t close to term, one of the first things that may be done is re-hydration. You may be given fluids and possibly an IV. Preterm contractions can many times be directly related to dehydration. If your contractions stop after re-hydration, you will more than likely be discharged with orders to increase your fluid intake and follow up with a visit with your doctor or midwife, without any medications. If you are thought to be in labor preterm (before the 37th week of pregnancy), you may be given antibiotics to prevent (or treat) possible infection, especially if your membranes have ruptured.

    If re-hydrating you doesn’t stop contractions, then you will most likely be given medication. There are typically two types of medications given to women who are having preterm labor. The first type helps to slow down or stop labor contractions if given early enough (they are called “tocolytics”) .The second type helps the baby’s lungs mature before birth (“corticosteroid” medications).

    Tocolytic medications often used include terbutaline (or brethine), ritodrine, nifedipine, magnesium sulfate, or indomethacine. Each of these medications work in a different way, but the goal is to minimize the strength and number of contractions which may cause the cervix to dilate and efface. They may be given in an injection, by IV, under the skin or in the form of a pill. Your doctor or midwife may prescribe your medication to be administered by a ‘pump’, which delivers a small amount automatically through a device similar to that used by insulin dependent diabetics, while you stay in the hospital. Tocolytic medications are not as successful later in labor, if your membranes have broken, or if your cervix is already dilated beyond 2 centimeters. Tocolytics are not used if you have chorioamnionitis (an infection in the membranes around the baby), bleeding, abruptio placenta, severe preeclampsia or eclampsia, cardiac disease or other severe medical illnesses.

    Like other drugs, these medications are associated with side effects for you, as well as your baby. Before choosing a medication, you and your doctor or midwife must weigh the risks and benefits of each. Possible side effects of some of these drugs include (but are not limited to): drowsiness, dizziness, headaches, muscle weakness, irregular or fast heartbeat, nausea, vomiting, nervousness, restlessness, insomnia, shaking, shortness of breath, hyperglycemia (high blood sugar) and hypokalemia (low blood potassium), double vision, fluid in the lungs, fever, hallucinations and heart attack. Possible side effects for the baby include: fast heart rate, high or low blood sugar after birth, loss of muscle tone, slow breathing, drowsiness, enlarged heart, jaundice and bleeding within the brain or heart. You and your baby should be monitored very closely while taking any of these medications.

    By delaying preterm labor with tocolytic medications, doctors and midwives can use other medications to help speed up the baby’s lung development and improve the baby’s chance of survival. Corticosteroid (or steroid) medications are given, particularly if delivery appears to be inevitable. Betamethasone (also called celestone) or dexamethasone are given by injection into muscle tissue.

    Sometimes, if an incompetent cervix has been diagnosed, a cervical cerclage may be done. This is a procedure where the cervical opening is stitched to keep it closed. Early cerclage placement has a significantly higher success rate than those performed after effacement and dilation have occurred. Bedrest (either at home or in the hospital) may be recommended, with varying levels of activity (from limited to none). It is important for you to discuss with your doctor or midwife what range of activity you may participate in when bedrest is prescribed.

    Back to Labor Stages

  • The Second Stage of Labor

    During the second stage of labor, your cervix is fully-dilated to 10 centimeters and as your baby makes his or her way down the birth canal, your contractions may actually space out to about 2-4 minutes apart and become more regular. This may allow you to rest and take a breather briefly between contractions. Although it may be difficult, rest and save your strength for pushing.

    Pushing and Delivery

    At this point, the pressure on your rectum increases and the urge to push becomes overwhelming, as your baby descends. You may feel more in control once pushing begins, as well as a sense of relief to be able to play a more active role in the birth process. You may also experience a burst of renewed energy as delivery draws ever-so-close. The urge to push usually feels the strongest at the peak of a contraction, then fades toward the end.

    Positioning and breathing will impact your pushing. Unless you are making significant progress, you may be advised to change positions about every half hour, which may enhance progress. Allow your partner (or support person) to help you into a semi-sitting or a semi-squatting position, which allows gravity to work for you, not against you. Squatting utilizes gravity, helping your pelvis to open up and make more room for your baby. It can also take some pressure off your back. Some hospitals even have squat bars that you can hold onto, or you can use your partner for added support.

    The side-lying position may also help ease back pressure, if you are experiencing “back labor” during pushing. For this position, you or your partner may hold up your top leg. A common position for pushing is having your feet in stirrups, while lying on your back. This position is most convenient for your doctor or midwife if you need an episiotomy, although gravity doesn’t help you out much while using this position.

    Whatever position you choose when pushing, take a deep breath, hold it in, bear down and concentrate. Curl into the push as much as you can, rounding your shoulders, putting your chin to your chest, allowing all of your muscles to work to help ease your baby into the world. Don’t be alarmed if you pass small amounts of urine or feces during the pushing stage, because many women do and it’s completely normal. It can even mean you are pushing effectively. Remember, every push brings you that much closer to holding your baby in your arms.

    Birth

    Some women want to use a mirror to see their baby’s head and may want to touch it as well. Seeing or feeling your baby’s head crown may give you added inspiration to keep pushing. Just before your baby is born, you may feel a burning, stinging or stretching sensation at the opening of your vagina. This often happens as your perineum widens to allow your baby’s head to descend (often called “crowning”) and your baby to pass through the birth canal.

    As your baby’s head emerges, it typically turns to one side to allow the shoulders to align. Once your baby’s head is delivered, you may be asked to stop pushing, so his or her airway can be cleared of excess mucus, by suctioning your baby’s nose and mouth. After that’s done, your doctor or midwife may assist the rest of the body out, usually with one last push. Congratulations! You have a brand new baby!

    Back to Labor Stages

  • Signs of Labor

    It’s not known what brings labor on, but it’s believed that hormones such as prostaglandins stimulate uterine activity and trigger oxytocin release, softening and thinning the cervix. Your body goes through a series of changes when it’s preparing for labor. Although the signs vary from woman to woman (as well as from pregnancy to pregnancy), once your labor has begun, the strong, painful contractions will ultimately give you a clue that it’s time for your little one to be born.

    At first, especially if this is your first pregnancy, you may not know the difference between true labor and false labor signs, making you unsure of what exactly you are experiencing. Becoming familiar in advance with the signs of labor will help you to distinguish the difference when the time comes. If you think you may be going into labor, don’t feel embarrassed to call your doctor or midwife to ask questions, no matter what time of day or night, or go to the hospital.

    Diarrhea, Nausea, Increased Energy

    Labor can start out with signs as simple as experiencing frequent diarrhea and nausea/upset stomach. Some women find themselves suddenly flooded with energy, when the nesting instinct kicks in full-force. Lower back pain and abdominal cramping aren’t uncommon either.

    Rupture of Membranes

    If you’re water breaks, that’s a definite sign that your time is drawing near of holding your little one. When your membranes rupture, it can feel like a little trickle or a big gush of fluid. This is the amniotic fluid that has surrounded your baby in the amniotic sac for nine months. Many times, your water won’t break until later stages of labor, or may even have to be broken manually by your doctor or midwife at the hospital. If you think your water has broken, call your doctor or midwife, because they will most likely want you to come to the hospital. The longer between when your water breaks and when delivery occurs, the greater chance of infection. Use a towel or pad to make you feel more comfortable, never use tampons while pregnant.

    Loss of Mucus Plug

    You may experience the loss of your mucus plug or “blood show” at the onset of labor, although it can occur as early as 2-3 weeks before delivery. This mucus-like discharge may be thick, bloody and stringy. This “plug” is the barrier that seals the opening of your cervix throughout pregnancy, preventing infection. Sometimes it dislodges as your cervix begins to thin and dilate (open). Make sure to let your doctor or midwife know if this happens, especially if it’s heavy and bright red, which could indicate something serious.

    Contractions

    Labor contractions start out similar to Braxton-Hicks contractions, beginning mild and relatively painless. But unlike Braxton-Hicks, they progressively get stronger and longer in duration. Also, true labor contractions will not let up by changing positions or resting, which false labor contractions tend to do. They continue and don’t go away, no matter what you do, they may even get stronger and intensify with activity. When you are really in labor, your contractions gradually become more regular and typically develop a pattern. They commonly begin in your lower back and radiate forward, like waves. False labor contractions are usually just centered in your abdomen and stay there. Your abdomen will feel very hard (usually much harder than Braxton-Hicks), like a basketball during these contractions, which you can feel by placing your hand on your belly. And unlike false labor contractions, real contractions will dilate and efface your cervix.

    Back to Labor Stages

  • Stages of Labor

    Every woman’s labor is different, following it’s own pattern (even from pregnancy to pregnancy) and there are some things that can’t be anticipated. Although every labor and birth is unique and your labor will unfold in a very special way, the process is remarkably and beautifully constant. You can expect a sequence of events, when everything goes smoothly.

    Labor is typically divided into three distinct stages. The first stage being when your cervix softens, dilates and thins out (effacement), ending in full dilation.

    The first stage can be divided into three “phases”: the early (or latent phase), the active phase and the transition phase. The second stage of labor is when your baby passes through the birth canal and is born. During the third stage, the placenta (afterbirth) is delivered.

    —Signs of Labor
    —Preterm Labor
    —Preterm Complications
    —Preterm Labor Causes
    —Preterm Prevention and Treatment
    —First Stage: Phase I
    —First Stage: Phase II
    —First Stage: Phase III
    —Second Stage
    —Third Stage
    —Induction of Labor
    —Induction of Labor Procedures
    —Labor Induction Risks
    —Do It Yourself Labor Induction

  • The First Stage of Labor – Active Labor

    During the second part of the longest stage of labor, your cervix really opens up, continuing to dilate from about 4 centimeters up to 8 centimeters. Your contractions continue to become more intense, more regular and last longer, as your labor progresses. They get closer together, eventually about 3-5 minutes apart and may last over a minute each, as your baby gets in position for birth. Read more on labor below:

    Active Labor

    Physically, you may be feeling increasing pressure and pain in your back. You may be much less comfortable than the earlier phase, as your labor pains intensify and become more frequent. During this phase, you may feel more fatigue, leg discomfort and increasing mucousy discharge (bloody show), as well as diarrhea. If your water didn’t break earlier, it will now or your doctor or midwife may choose to rupture your membranes sometime during this phase. During active labor, some women request an epidural or other pain medication.

    Emotionally, you may feel increasingly restless and anxious, especially if this phase lasts a long time. Your mood may become more serious and your initial excitement may begin to wane as your pain gets worse. You may find it very difficult to concentrate, while dealing with contractions and your support person can help keep you focused.

    At this point, you will be headed for the hospital or there already. To reduce your growing discomfort, try breathing exercises and relaxation techniques (the ones that you may have learned in childbirth class), if you feel like doing them. Concentrate on resting and relaxing, because the more relaxed you are, the easier and quicker your labor may be. Soaking in a warm bath or taking a shower, may be helpful at this time. Experiment with different positions to find ones that are more comfortable. Discomfort can often be helped by positions that allow gravity to speed dilation, including walking, squatting or rolling on a birth ball. If you are confined to bed, try lying on your side.

    If your doctor or midwife agrees that it’s alright to do so, drink clear liquids or suck on ice chips to keep from becoming dehydrated and also to keep your mouth from becoming dry. If you become hungry, you can ask if it’s okay to have a light snack, such as Jell-O, although many hospitals won’t allow you to eat anything during labor. In between contractions, get up and walk around, if possible. Take this time to use the bathroom, because urinating regularly will allow your baby’s head to move down more easily into the birth canal. A gentle massage from your partner (or support person) may be welcomed, although some women prefer not to be touched during this phase of labor.

    Back to Labor Stages

  • More on Episiotomies (continued)

    Many recent studies have shown that routine episiotomies shouldn’t be performed, because they are not helpful to the majority of women, although there are certain circumstances when they are needed. Having an episiotomy can increase pain during the postpartum period, leading to a longer recovery time. In addition, women who have episiotomies may have weaker pelvic floor muscles as well as more pain when resuming intercourse postpartum.

    Episiotomy rates have declined over the years, but the number still remains high. Despite all the evidence against routine episiotomy use, close to 50- 80% of first time moms end up with an episiotomy in the U.S. The majority of women having them done are young white women, who have private insurance, according to a recent study.

    There are a few situations when an episiotomy may be medically necessary. If there is a sign that your baby is in distress while in the birth canal, such as slowing of your baby’s heart rate, an episiotomy may be unavoidable for the sake of your baby’s well-being. If your baby’s shoulders get stuck, if your baby has a very large head that cannot fit through the vaginal opening or if delivery happens too quickly for the skin of your perineum to stretch naturally, you may need an episiotomy.

    Perineal message helps reduce the chance of tearing during birth and the need for an episiotomy. It can make the perineum more flexible and increase elasticity, in preparation for birth. It’s a good idea to start doing perineal massage around the 34th week of pregnancy or before. To perform perineal massage, wash your hands thoroughly (or your partner). Place K-Y jelly, vitamin E oil or another mild lubricant on one or two fingers and gently stretch the lower part of the vagina until you feel a slight burning sensation. Hold the pressure steady for about 2 minutes or so. Repeat this daily for about 8-10 minutes.

    Warm compresses during labor (especially during the pushing stage) encourage the stretching and relaxing of the perineum. Make sure they are only warm, but not hot, which can cause some swelling. Positioning during labor and birth may contribute to whether you need an episiotomy or not. Squatting can help reduce tearing. Avoid laying directly on your back, if possible and keep changing positions if you can. Talk to your doctor or midwife early about your feelings regarding episiotomies, especially if you wish to avoid one.

  • Depression During Pregnancy (continued)

    Possible triggers for prenatal depression include: family or personal history of depression, relationship problems or martial conflict, living alone, unplanned pregnancy, financial troubles, a complicated or high-risk pregnancy, being confined to bed rest, fertility treatments, previous pregnancy loss (fear that something may happen to this pregnancy), stressful life events (such as a recent death in the family, divorce, separation or job loss), being young at the time of pregnancy, history of substance abuse, limited support from family and friends as well as past history of being abused either emotionally, sexually or physically. There may be a number of reasons why a woman may get depressed during pregnancy, although at other times, the cause isn’t quite as clear.

    Depression during pregnancy can be dangerous, since when it’s severe, it may result in decreased ability for women to care for themselves or their unborn baby, along with interference with prenatal bonding. Women may not eat properly, get adequate rest or receive prenatal care. Depression can also put women at risk for increased use of substances such as tobacco, alcohol and drugs. Women with severe depression may be at a much higher risk of suicide, if the depression is left untreated. Depression during pregnancy is linked to premature delivery, low birth-weight and possibly even depression and behavioral problems later on in the child.

    In addition, depression during pregnancy is one of the strongest predictors of postpartum depression after delivery. About 50% of women suffering from depression during pregnancy go on to develop postpartum depression. The good news is treatment during pregnancy can reduce that number dramatically.

    Many women suffer needlessly because they don’t seek help. Depression can be treated and managed during pregnancy, but the first step of seeking out help and support, is the most important. Treating depression is just as important as treating any other health concern during pregnancy. Without proper treatment, depression can get worse or be harmful to the baby or mother.

    If you suspect that you are becoming depressed, it’s important to talk to your doctor or midwife about how you are feeling. He or she may want to prescribe anti-depressant medication and/or refer you to a therapist who can provide you with some much-needed support, if your depression is moderate to severe. Besides medication and therapy, alternative approaches include light therapy, support groups as well as self-help approaches that may help you feel better. These include: building a support network that can help with such things as household responsibilities, preparing meals and other daily tasks to help keep you from feeling fatigued, exercising, which can be very beneficial, especially walking and stress management. Make sure to take plenty of breaks, get adequate amounts of sleep and eat a well-balanced diet. Talking things out with your friends, partner and family may also be very helpful.

    << Postpartum Depression >>

  • 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).