Sunday, September 9, 2007

C-Section Delivery

A caesarean section can literally be a lifesaver for mother and child. But as the number of caesarean-born babies increases sharply, so does the need to be informed.

Successful C-sections have become commonplace but they are still major surgery.

The impact and risks associated with caesarean surgery should not be underestimated. There is a possibility of injuring the bladder or intestine. Compared to vaginal deliveries there is greater chance of blood loss and of infection.

Whether you’re considering an elective C-section or want to understand emergency procedures, do not give consent before you are entirely well informed.

In 2004, C-section deliveries accounted for 29.1 percent of all births in the U.S.

The number of caesareans has increased by 40 percent since 1996. Primary factors: lawsuits brought by patients, which influence many obstetricians to practice medicine defensively; a sharp rise in demand by patients who fear labor pain; and the refusal of many hospitals to allow vaginal births if a mother has delivered by C-section before.

A mother who has delivered by C-section may still be able to deliver her next baby vaginally.

There is great controversy in the OB-GYN community regarding vaginal birth after caesarean, or VBAC. Since 1996, the VBAC rate has dropped by 67 percent.

Hundreds of hospitals and obstetricians forbid VBACs altogether, citing the risk of a uterine tears—and the malpractice suits that follow. They also oppose having emergency surgical teams on standby for when VBAC attempts fail.

Advocates of VBAC argue there are too many known and unknown risks in repeated C-sections. Each successive caesarean delivery is more complicated because there is scar tissue on the uterus from the prior procedure. Also, the placenta is more likely to grow abnormally after multiple caesareans, which can lead to haemorrhage and other serious complications.

Expectant mothers should understand what constitutes a caesarean as “medical necessity.”

An emergency C-section may be necessary if there is fatal distress, if labour has stopped progressing, or if the mother’s well-being is threatened.

In some cases a C-section is scheduled in advance because it’s clear that vaginal delivery would not be safe. The fetus may be positioned poorly or may be too big, or the mother may be at high risk of a uterine tear due to a prior C-section.

In a successful C-section with a healthy patient, recovery can be rapid.

Most women are walking within 12 hours of surgery and can take liquid and food the same day. Usually after three days, new mothers can be sent home with pain medication such as Vicodin or Tylenol with codeine. Discomfort from the abdominal incision tends to be more severe and longer lasting than experienced by women with healthy vaginal delivery. Nonetheless, moms in each group are frequently back to normal within six to eight weeks.

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