Health Talk: An advertising supplement to The Morning Journal
Cesarean section or cesarean birth is the delivery of a baby through a surgical incision in the abdominal wall.
Cesarean birth has become the most common hospital based operation in the United States accounting for 32.8% of all births. This is a significant increase from the 4.5% that it was in 1965.
The increase is believed to be due to the liberal indications for “fetal distress” (a term that is no longer used), failure to progress, breech presentation (where the baby presents by the buttocks or feet first), and elective repeat cesarean deliveries where the mother or obstetrician decide to do a repeat cesarean delivery by choice.
Cesarean delivery is associated with death of the mother in 20 out of 100,000 births in the United States and even though this represents an infrequent outcome it is obviously devastating when it occurs. Cesarean delivery can also result in many complications including increase in the rate of infection after the delivery, and increased risk of significant blood loss and the need for blood transfusion with its potential complications. Also, there is an increased risk of anesthesia complications and complications of the surgery itself, such as unanticipated injury to surrounding structures as can occur in all surgical procedures.
In spite of this, little public attention has been given to the consequences of this major surgical procedure and its effect not only on a current pregnancy but also on future pregnancies.
As the percentage of laboring patients with prior cesarean births has increased there has been an increase in more difficult repeat cesarean deliveries and their complications. These include an increase in the frequency of placenta previa where the placenta implants in the lower part of the uterus sometimes completely covering the cervix making normal delivery impossible.
There is also an increase in the frequency of placenta accreta where the placenta grows into the muscle of the uterus making it difficult to remove it and often requiring a hysterectomy (removal of the uterus). Prior cesarean births can also result if rupture of the uterus with severe hemorrhage also requiring a hysterectomy.
Of all these complications, placenta accreta is the most feared because it can lead to uncontrollable hemorrhage and a high mortality rate. The more cesarean births a patient has the higher the chance that she may have one of these complications, including placenta accreta.
When there is placenta previa in the presence of a prior cesarean section, the chance of placenta accreta increases significantly, it therefore, makes sense to limit the number of cesarean deliveries a woman has.
Obviously, when a cesarean delivery is clearly indicated it should be performed.
Examples of these situations include prolapse of the umbilical cord, (where the umbilical cord comes before the baby), placenta previa, placental abruption (where a portion of the placenta separates from the uterus before birth), HIV infection to reduce the chance of transmission of HIV to the baby, conjoined twins and some other conditions. Breech presentation is included in the above but there is an opportunity to sometimes convert a breech presentation to a normal presentation if it is diagnosed before labor.
In many situations however, patience on the part of the patient and her attendant can be rewarding.
The laboring patient needs support and encouragement throughout her labor from her family, the nursing staff, and her attendant so she does not give up and opt for a cesarean delivery prematurely.
Cesarean delivery for convenience should be frowned upon because of the potential consequences mentioned above.
Trial of labor after one low transverse cesarean birth where the incision was made transversely across the lower part of the uterus is worth doing in the proper setting and with informed consent. Monitoring of the baby’s heart rate and the contraction pattern of the uterus should be interpreted knowledgeably because inappropriate interpretation of fetal monitoring can lead to an unnecessary increase in cesarean section rates.
Not all fetal heart rate abnormalities require a knee jerk response to do a cesarean birth. There is often time to use resuscitative measures to correct the heart rate abnormality and keep the baby safe and patients should know this and not panic and demand a cesarean birth immediately there is a fetal heart rate abnormality.
The presence of the attendant during critical stages of the labor can be assuring for the patient, and the use of obstetric maneuvers to guide the baby in the optimal position with the baby’s face looking down instead of up can facilitate delivery and reduce the frequency of cesarean delivery for a prolonged second stage of labor.
For further questions, call 440-960-0644.