Posts Tagged ‘C-section’

Breech birth

Friday, October 12th, 2012

Most babies prepare to enter this world head first. A small percentage of babies, however, don’t make that final turn and end up offering themselves feet or fanny first. This is called breech presentation.

We’re not sure why these babies don’t turn, but it does appear more common under these circumstances:
  • When there has been a previous breech presentation
  • In pregnancies of multiples (twins, triplets…)
  • When the amniotic fluid is abnormally low or high
  • If a woman has placenta previa
  • If her uterus is abnormally shaped or if she has fibroids
  • If there is a history of premature delivery

If a breech presentation is suspected, an ultrasound will confirm it. Most breech babies are born healthy, but there may be a slight increase in the risk of the baby having a birth defect and closer examination may be offered.

When a baby is in a breech position, health care providers will try to encourage it to turn into the head down position some time between 32 and 37 weeks. There are different ways to attempt this and it’s important for a woman to discuss the options with her provider to determine which is safest for her pregnancy. These are a few of the options (no guarantees that any of them will work, though):
  • External version – This may require medication to relax mom’s uterus. Essentially, this involves the provider pushing on the lower abdomen to rotate the baby. It is monitored by ultrasound and the fetal heart rate is checked regularly. This is not an option for women carrying multiples, in cases of low amniotic fluid, or when a woman has had previous c-sections.
  • Chiropractic care – The Webster technique is used to reduce stress on the woman’s pelvis, optimize its mobility, decrease the tension on the uterus and relax supporting ligaments. This regional relaxation makes it easier for the baby to turn on his own.
  • Breech tilt – Mom lies flat on her back and then raises her hips about 12 inches off the floor and supports them with pillows. She stays in this position for about ten minutes, three times per day. This can be alternated with Mom resting her head on a pillow and raising her hips up, resting on her knees. These positional shifts let gravity help move her baby. 
  • Hypnosis – A good hypnotherapist may be able to place a woman in a state of deep relaxation which might make it easier for her baby to turn.
  • Moxibustion – Used to stimulate the baby’s movement, this is an ancient Chinese technique that involves burning herbs and focusing on acupressure points, typically performed by an accupuncturist.

When babies still don’t turn, most will be delivered by cesarean section, though not before 39 weeks if all is going smoothly. While most providers will not consider it, there are occasional circumstances when a vaginal delivery might be possible in a breech position. In such cases, a woman wants to be sure that her provider is well experienced in these types of deliveries. She should be mindful that cesarean may still be a necessary final outcome.

Watching the new PBS series “Call the Midwife” last week inspired this post. Did you see it? What did you think?

Cesarean – it’s major surgery

Monday, April 11th, 2011

I went to a conference recently that focused on how to reduce the number of cesarean deliveries in the U.S.  Nurses, docs and other health professionals attended and it was very interesting.  It became apparent that many women ask their provider to schedule a cesarean delivery for convenience or to avoid the pains of childbirth. Our focus was about how to convince women that cesarean has risks and, unless there is a problem, it’s better for mom and baby to stay the course and deliver vaginally.

Concern about pain is usually not a good reason to request c-section. Safe and effective pain management methods are available to help women cope with vaginal delivery. Some of these methods use drugs; others are drug-free.

Having your baby early, even if it’s just by a week or two, can make a difference in your baby’s health. For example, the brain and lungs are still growing. And there are some risks to a baby associated with mom receiving anesthesia.  A c-section may affect the health of your future pregnancies, too. That’s because there’s a greater risk of pregnancy complications,  such as placenta previa, with every c-section you have.

It takes 4 to 6 weeks or longer to fully recover from a c-section. Recovery from a vaginal birth is shorter. Also, the hospital stay for a vaginal birth is 2 days. But with a c-section, you’ll probably stay 3 to 4 days in the hospital.  This may prove more expensive, especially if your health plan does not cover cesarean for non-medical reasons.

If you’ve already had a c-section and are pregnant again, talk to your provider about having a vaginal birth after c-section (VBAC). There are several medical reasons for repeat cesarean delivery,  but for many women, a VBAC can be a healthy, safe choice for birth.


Tuesday, October 26th, 2010

babyfaceMacrosomia is a term that describes an unusually large baby, weighing more than 9 pounds 15 ounces.  Aside from genetic factors (others in the family are really big), one of the main causes of macorsomia is poorly controlled diabetes during pregnancy.  Increased maternal plasma glucose levels, as well as insulin, stimulate the baby’s growth.  Pregnant women who are obese are at increased risk of having an overly large baby.  If a baby goes way past its due date, it may be overly large.  Interestingly, more male babies are macrosomic than girls, and if you have had one overly large baby you may be at increased risk of having another large baby in a future pregnancy.  I know a guy who is one of four boys, each of whom weighed over 14 pounds!  I kid you not.

With a really big baby, there is the chance of having a difficult birth.  The mother may experience perineal tearing, significant blood loss, and even damage to her tailbone.  The baby’s shoulder may get caught behind the mother’s pubic bone causing a dangerous situation and a threat to both the mother and baby, including possible infant death.
Some doctors will plan a cesarean delivery if a woman appears to be carrying a very large baby.  Unfortunately, late third trimester ultrasounds are not particularly accurate at measuring the baby’s size and many planned, cautionary cesarean deliveries turn out to be unnecessary.  It is always important to go over the risks and benefits to both mom and baby when discussing a planned cesarean delivery.

If you are planning for a baby in you future, now is the time to get your weight under control.  If you have diabetes, be sure to manage it carefully so that it is as controlled as possible during your pregnancy.  If you have recently had a very large baby and had gestational diabetes, make sure your doctor tests you for diabetes a few months after delivery.  Up to 20% of women who had gestational diabetes end up with postpartum diabetes and will need to manage it.

Twins & triplets have greater odds of needing a NICU

Thursday, August 12th, 2010

tripletsToday, more than 3 percent of babies in this country are born in sets of two, three or more; about 95 percent of these multiple births are twins. The high number of multiple pregnancies is a concern because women who are expecting more than one baby are at increased risk of certain pregnancy complications, including premature birth (before 37 completed weeks of pregnancy).

About 60 percent of twins, more than 90 percent of triplets, and virtually all quadruplets and higher-order multiples are born premature. The length of pregnancy decreases with each additional baby. On average, most singleton pregnancies last 39 weeks; for twins, 35 weeks; for triplets, 32 weeks; and for quadruplets, 29 weeks.

More than half of twins and almost all higher-order multiples are born with low birthweight (LBW), less than 5½ pounds or 2,500 grams.  LBW can result from premature birth and/or poor fetal growth. Both are common in multiple pregnancies.

LBW babies, especially those born before about 32 weeks gestation and/or weighing less than 3 1/3 pounds (1,500 grams), are at increased risk of health problems in the newborn period as well as lasting disabilities, such as mental retardation, cerebral palsy,  and vision and hearing loss.   While advances in caring for very small infants has brightened the outlook for these tiny babies, chances remain slim that all infants in a set of sextuplets or more will survive and thrive.

Preeclampsia and diabetes in the mother are two conditions that, for the safety of the mother and baby, can lead to an early delivery. Women expecting twins are more than twice as likely as women with a singleton pregnancy to develop preeclampsia. Gestational diabetes can cause the baby to grow especially large, increasing the risk of injuries to mother and baby during vaginal birth and making cesarean delivery more likely.  Babies born to women with gestational diabetes also may have breathing and other problems during the newborn period.

Have you or someone in your family had twins or triplets?  Were they in the NICU?

New guidelines on vaginal birth after c-section

Thursday, July 22nd, 2010

It used to be that once you had a c-section, you’d always have a c-section. Now, health experts are rethinking this idea and believe that many women may be able to safely have a vaginal birth after a c-section (called VBAC).

The American College of Obstetricians and Gynecologists today released guidelines to make it easier for more women to have VBACs by encouraging health providers to consider VBACs as an option for healthy pregnant women. In fact, about 6 to 8 out of 10 women who try a VBAC are successful in having a vaginal birth. Even women who are carrying twins and had more than one c-section in the past may be able to have a VBAC safely.

While there may be some risks in doing a VBAC (as with childbirth in general), it can be safe for many healthy women and their babies. The benefits of having a VBAC include a lower chance of infection, blood loss or other health complications associated with c-sections as well as a shorter recovery time after giving birth. You’re more likely to have a successful VBAC if:
• Your c-section cut was made in the lower part of the uterus
• Your health and baby’s health are well during pregnancy.
• Your labor starts on its own and continues naturally at 37 to 40 weeks of pregnancy.

If you had a c-section and are pregnant again, talk to your health provider to see if a VBAC is the right choice for you.

C-section rate the highest it has ever been in the U.S.

Thursday, March 25th, 2010

Nearly one-third of all births in the U.S. were via cesarean section in 2007. According to a new study out this month, the rate of cesarean delivery rose by 53% from 1996 to 2007.  An increase showed for mothers of all ages and across racial and Hispanic-origin groups.  And an increase was seen in every state in the country, six states with an increase as high as 70%!

Cesarean section is delivery of a baby by major abdominal surgery.  Like any major surgery, there are certain risks associated with cesarean delivery. C-section, however, can be a lifesaving operation when either you or your baby face certain problems before or during labor and delivery.  Because cesarean section is major surgery, it should be performed only when the health of the mother or baby is at risk.

According to the study, cesarean rates were higher for both early and late preterm infants (before 37 weeks) than for term infants.  Preterm infants are more likely to have medical problems than babies born a few weeks later at full term. These babies often spend time in the NICU (neonatal intensive care unit) receiving expert, yet costly, care.  (The hospital cost of a cesarean birth alone usually is twice that of a vaginal birth.)

If you are thinking about cesarean delivery, carefully consider the risks and benefits for your baby and yourself.  Make a list of your questions and have a serious discussion about your options with your health care provider.

Diabetes Awareness Day

Tuesday, March 23rd, 2010

One third of women with diabetes don’t know they have it – that’s one out of every three women with diabetes, a lot!  Today is Diabetes Awareness Day.  We’ve posted on the importance of getting diabetes under control before you conceive and keeping it under control during pregnancy, but today is a good opportunity to mention it again.

This is really important ladies.  If too much glucose (sugar) is in a woman’s blood during early pregnancy, there’s a chance that this can cause birth defects of the brain or spine, heart defects, cleft lip or palate, kidney problems, etc. In later pregnancy, too much glucose could lead to high blood pressure in the mom, a baby that is too large or born prematurely, a cesarean delivery or other life-threatening situations.

Pre-existing diabetes may also increase the risk of miscarriage and poorly controlled diabetes later in pregnancy may increase the risk of stillbirth.

But don’t panic, because paying attention now has excellent benefits.  Most of these women can look forward to having a healthy baby. While diabetes poses some risks in pregnancy, advances in care have greatly improved the outlook for these pregnancies. So make sure you get your preconception checkup, fine tune any issues and be as healthy as possible before you conceive.

Vaginal birth after c-section: Is it safe?

Thursday, March 11th, 2010

mom-with-newbornIs it safe to have a vaginal birth once a woman has had a c-section? That’s the question medical experts asked this week at the National Institutes of Health (NIH). Vaginal birth after cesarean is called VBAC for short.

Some women want to deliver vaginally after they’ve had a c-section. They may want a “more natural” experience, or they may want to avoid having surgery again.

Yet many women have trouble finding a medical provider or hospital who will consider VBAC. Hospitals and providers worry about safety and about the risk of being sued.

The NIH experts concluded that, while there are risks involved, VBAC can be safe for many women. They encouraged hospitals, providers and women to work together. Everyone needs to consider the risks and benefits for the particular woman and her baby. When it makes sense, the woman should have the option to choose VBAC. The panel also called for more research.

Have you had VBAC? Or have you wanted to? Let us hear from you.

Mom had cesarean deliveries. Does that mean I will?

Thursday, October 29th, 2009

baby-has-arrivedNope.  Sometimes genetics plays a part (for example, you and your mom both have a uniquely shaped uterus, a liver disease, diabetes or high blood pressure), but usually your mom’s birthing history will not impact yours.

C-section, or cesarean delivery, can be a lifesaving operation when either you or your baby face certain problems before or during labor and delivery. Read more about reasons for cesarean section and watch our videos at this link.   Many women who deliver surgically never planned to do so, but an emergency made it necessary.  Some health care experts, however, believe that other, non-emergent c-sections are not medically necessary. A cesarean section is major surgery and should be done only when the health of the mother or baby is at risk.  Even if you had your first baby via cesarean delivery, you may or may not need to deliver a second baby that way. It all depends on the reasons for performing the first cesarean and how the incisions were placed in your body.  It’s important to discuss this with your health care provider before your next birth experience.

Infections after c-section

Thursday, August 13th, 2009

mom-with-newborn1Did you know? Women who have a c-section are more likely to develop a postpartum infection than women who have a vaginal delivery.

A new study from Denmark looked at the records of over 30,000 women who had given birth. Those who had a c-section were at increased risk of having a urinary tract infection (UTI) or a wound infection within the first 30 days after delivery. (A wound infection affects the area where the incision was made.) Other studies have also found an increased risk of infection after cesarean.

So if you have a c-section, be on the alert for these signs:

* For a UTI, watch for pain or burning when you go to the bathroom, blood in your urine, fever and the urge to go often.

* For  wound infection, watch for redness, swelling or pus around the incision site. Sometimes, the wound may open, and you may run a fever.

For more information, read the March of Dimes article on cesarean birth. Or watch our video C-Section: Recovering After Surgery.