The push for C-sections May 2012

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After a long nine months of pregnancy, giving birth to your much-anticipated child is truly a miracle. And every woman’s story is unique and special to her.

Currently, the issue on the horizon is a burgeoning interest by some women to bypass consideration of vaginal delivery and go straight to a caesarean section, said Dr. Kevin Kiley, associate professor and chairman of the Department of Obstetrics and Gynecology at Albany Medical College and chief of obstetrics services at Albany Medical Center.

Back in the late 1970s when he was doing his training, the rate of women having c-sections was 10 percent. “The guys who were teaching me trained in the late fifties and early sixties and if the c-section rate got up to five percent, they thought something was wrong,” he said.

Today, the March of Dimes reports that as of 2008, 34.5 percent of live births were caesarean sections. This is an all-time high and a concern to the March of Dimes who are devoted to the health of mother’s and their babies.

At Albany Medical Center in downtown Albany, doctors treat a higher rate of high-risk pregnant women, resulting in higher than normal rates of c-sections, said Dr. Kiley.

In general, there are two reasons to perform a c-section: maternal indication and fetal indication.

Maternal indication means that the mother can’t tolerate labor and delivery for any number of reasons. It can be that she has diabetes or hypertension or severe preeclampsia. Other factors might include a baby who is not progressing during delivery because the size of the mother’s pelvis cannot accommodate the baby’s passage, which is typically associated with diabetic mothers.

Fetal indications can include the position of the baby (i.e., the baby is breech); the presence of twins; the rate of the baby’s heartbeat; abruptions of the placenta; the placement of the cord around the neck of the baby (about 25% of pregnancies have the cord around the neck, said Dr. Kiley, which can decrease the baby’s heartbeat); or the baby has spina bifida.

Outside of these special circumstances, Dr. Kiley also meets with many patients who prefer a c-section to the labor process, especially first-time mothers-to-be who have anxieties about giving birth, and women who have already had a first or second c-section and want to do the same for subsequent deliveries, though Dr. Kiley is skeptical of the maxim of “once a c-section always a c-section”.

If you’re following the Hollywood baby buzz, many celebrities have been reported to request one. Beyonce is said to have had one, as has Victoria Beckham.  Jessica Simpson is said to have requested one because she is terrified of the pain associated with labor. Other women might want a c-section for social reasons: her mother is in town for the birth; her husband is leaving town on business; she wants to choose the birth date; or she is simply just tired of being pregnant.
If the pregnancy is problem-free, a woman can have an elective c-section, but not a day before 39 weeks. “That is non-negotiable,” said Dr. Kiley.

“When patients come in [wanting a c-section], I’m not trying to change their minds; I’m trying to make sure they clearly understand the risk and complications,” said Dr. Kiley. “It’s a big enough operation to include risks, up to death, which is very rare,” he said.

Many doctors are perfectly fine with doing an elective section after 39 weeks, he added. According to the American College of Obstetrics and Gynecology (ACOG), that isn’t an unreasonable thing, as long as the patient is informed.

While a c-section may seem the easier delivery route for some people, the post-delivery experience may be a little different.
“When you have a vaginal delivery, and all things go well, you can start immediate bonding with your baby with skin-to-skin contact.” With a c-section, the baby goes right to warming room and then usually the father holds the baby while the mother looks on. “The IV’s make it a little harder to connect, but it’s not the end of the world,” said Dr. Kiley.

Additionally, recovery for the mother is longer. According to the March of Dimes, a woman can expect to stay in the hospital three to four days with full recovery lasting four to six weeks. Following a vaginal birth, the hospital stay is usually two days and full recovery takes less time.

While it’s natural curiosity to want to search the web for what to expect regarding delivery and recovery, Dr. Kiley cautions women against this. There are some patients who express concerns that a vaginal delivery will affect their pelvic structure in the future (prolapsed uterus or incontinence issues, for example).
“Be careful what you read on the Internet about pelvic structure,” he said. “Some women who have never been pregnant suffer from this. You’re not going to avoid that by having a c-section.”

The way in which a woman chooses to bring her child into the world is her personal decision. Sometimes it goes as planned, be it a vaginal birth or planned caesarean.  Sometimes, however, everyone’s mother – Mother Nature, that is – has her own plans.

The risk of late pre-term birth

According to the March of Dimes, caesarean sections may contribute to the growing number of babies who are born "late pre-term," between 34 and 36 weeks gestation. While babies born at this time are usually considered healthy, they are more likely to have medical problems than babies born a few weeks later at full-term.

A baby’s lungs and brain mature late in pregnancy. Compared to a full-term baby, an infant born between 34 and 36 weeks gestation is more likely to have problems with:

  • Breathing
  • Feeding
  • Maintaining his or her temperature
  • Jaundice

It can be hard to pinpoint the date your baby was conceived. Being off by just a week or two can result in a premature birth. This may make a difference in your baby’s health. Keep this in mind when scheduling a c-section.
 

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