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Cesarean Sections
Q. What determines if I'll be able to deliver vaginally? I have very narrow hips and I am of small stature. Will I need a C-section?
-Angie, Colorado
A. Although small women with narrow hips may have a higher rate of Cesarean deliveries, it does not mean you cannot deliver vaginally. There are a number of factors that may affect your birthing outcome:
- Heredity: If your mother was also narrow-hipped and had to have C-section deliveries, your odds for a C increase.
- Weight gain: Less weight gain usually increases your chances for a smaller baby. A small baby is a lot easier to push out through an orange-sized hole than an almost nine-pounder like my first was.
- The baby's position: If the baby is head-down and "drops" prior to labor, your pelvis has the opportunity to work on opening up, increasing your chances for the vag birth.
- Labor Progression: If your labor progresses normally (without the aid of drugs, such as Pitocin), the chances for full dilation of the cervix and a vaginal delivery are better.
Q. I had my first daughter in September 2002. Two days before my due date, I went for a checkup and my blood pressure was high and I had some protein in my urine. The doctors decided to perform a C-section. I was a little shocked at the outcome to not even try to deliver vaginally, but my daughter and I turned out fine. I became pregnant again last April and informed the doctors that I desperately wanted to try for a vaginal birth. I am now about 32 weeks pregnant and the doctors recently told me I am measuring "large" and if I continue they will give me a sonogram one week before my due date to determine the baby’s size. They said at that point they will probably try to talk me into a C-section. Isn’t a vaginal birth better for everyone around? Why are the doctors so eager to do C-sections? I am not scared of a C-section itself– it’s the recovery that is the killer, especially with a 16-month old child. I am very frustrated but want to do the right thing. Should I switch doctors at this late date?
-Mary, New York
A. It sounds as if your doctor decided to do your first C-section because of the protein in your urine. High levels of protein could be related to toxemia and they probably wanted to get the baby out ASAP.
As far as your second pregnancy, twenty years ago, having a Cesarean automatically meant that all succeeding births would be done the same way. Today's doctors have learned that this doesn't have to be the case, nor is it always most beneficial. But, if you do have a C the first time, your chances for having another do increase.
I, too, had a C-section with my first child and was desperate to have a V-back the next time. During labor with my second child when my doctor was urging me to get the C-section, I considered, just for a moment, telling him that another C would be anti-climactic for my book. Did he really want to be the cause of my publishing downfall?
But seriously, if you can do it without risk to the baby, I would recommend the vaginal birth over a C-section. It is usually less pain and for a shorter period of time. Not only that, but you are right about the recovery– what a difference!
I'm not here to doctor-bash, but you should be aware that some obstetricians are more scalpel-happy than others. Believe it or not, there are doctors who would rather be on the golf course than doing overtime to deliver your baby vaginally. Nervy, huh?!
It may be wise to ask your doctor the rate of Cesareans in his or her practice. The World Health Organization (WHO) states that no region in the world is justified in having a Cesarean rate greater than 10 to 15 percent.
If you find that the practice has a large number of C-sections or your doctor is unwilling to discuss a plan for a V-back, then yes, you may want to consider changing doctors.
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Q. My wife is 33 years old and white (she does not meet the usual profiles for placental abruption), 36.5 weeks pregnant and the baby is weighing in at plus/minus 8.5 pounds. This will be her fourth C-section. My wife experienced placental abruptions with pregnancy #1 (at 40 weeks) and pregnancy #2 (at 34 weeks). Both turned out okay. She had no problems with pregnancy #3. Pregnancy #4 has been unremarkable to date and we want to keep it that way. The C-section for this pregnancy is currently scheduled for week 38. Our risk-averse doctor feels that we should go at 37 weeks and not take a chance. Our OB does not have preference.
We are not looking for you to tell us what to do, but rather to provide some data from your experience on some of the pluses and minuses for waiting or going (e.g. size of baby, stress on placenta) so we can make an intelligent decision.
-Chris, Massachusetts
A. Since your wife has had previous placental abruptions and this is her fourth baby, she is a high-risk candidate for another abruption. Typically, during the last few weeks of pregnancy, the baby isn't doing much more than putting on a little extra fat and has an excellent chance of survival. I can see why the doctor would want to schedule a C-section at 37 weeks.
Of course, every child is different. You may want to take into consideration how well the other babies fared being born a little premature. If the children had any problems as a result of an early birth, perhaps you can work out a compromise with the risk-averse doctor: plenty of bed rest for the last few weeks, close monitoring and a later C-section.
Q. I had a C-section about 23 months ago. While in the shower yesterday I felt a burning where my scar is and I looked downed to see what appeared to be a tear or a small hole on the line of my C-section. I am not the ideal weight, but I am not extremely overweight either. In the past I have not had any problems except for some tenderness in this area. What do you think the cause may be?
-Melanie, Louisiana
A. Since it's been almost two years since your surgery, I doubt it's a lingering infection or improper healing. You may have had some trauma to the area which was already weakened by the prior surgery. Something like slamming your hip against the kitchen counter (one of my least favorite, but frequent bumbles) may have ripped the scar open a little. It may need a stitch or two to close it back up, or simply a Band-Aid and some antibacterial ointment.
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Q. I just found out that I am five weeks pregnant with my second child. I had a C-section delivery with my son only seven months ago. Will my scar be strong enough to hold up to a VBAC or should I go for the C-section again?
-Mandy, Utah
A. It's amazing how quickly the human body can repair itself. By the time you are ready for delivery, your scar will be over 15 months old. Having given birth both ways, I recommend going for the VBAC (Vaginal Birth After Cesarean) if you can. For me, it was a much better experience all around—I experienced less pain and for a shorter period of time, and after giving birth I was much more coherent and able to hold my baby right away.
Q. What is the proper way to remove a sedated GYN patient from the stirrups after surgery? Are there any dangers of back injuries?
-Anonymous, Maryland
A. Since I am not a medical professional, I cannot tell you if there is a "procedure" to follow in this case. I will tell you that when I had my Cesarean the nurse just lifted my legs out of the stirrups and placed them down on the table after surgery, as the spinal block did not allow me mobility in my lower body. I've never heard of anyone incurring a back injury as a result of being removed from the stirrups, but I guess it could happen. Heck, a house could fall on you, too!
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Q. How soon after a C-section can you become pregnant? My husband and I had an accident and it has only been three weeks. Is it possible to become pregnant?
-Anonymous, Indiana
A. Most women will start ovulating again six to 18 weeks after delivery, if they are not breastfeeding. But, some women do ovulate while breastfeeding, too. You probably have not become fertile yet, but there's a small chance. It's best to always use some form of birth control if you don't want to get pregnant.
Q. I was told that once you have had three Cesarean deliveries that you cannot have any more children. Is this true?
-Anonymous, California
A. The amount of Cesarean deliveries your body can endure all depends on the type of incision you had (the low-transverse or the classical vertical), the kind of scar that formed and the reasons for the previous C-sections. I know of a woman who had eleven Cesarean deliveries, so, to answer your question, I don't think three is a standard limit. You should talk to your OB/GYN to discuss your options, because only someone familiar with your medical history can give you realistic expectations.
Multiple Cesareans do, however, put you at higher risk for uterine rupture caused by labor, because of multiple scarring. If you decide to take the route of multiple (more than three) C-sections, you should be on the lookout for any signs of labor or pre-labor and have your surgery scheduled well before your due date. Any sign of labor or pre-labor should be reported to your doctor immediately, whether it be cramping, possible breakage of water or even loss of the mucous plug.
Q. Six months ago I had a C-section and now I'm pregnant again. My doctor said that this was okay, but I just had my first sonogram and found out that I'm having TWINS! Could this be a problem?
-Jennifer, New York
A. You and your babies will most likely have no adverse effects from your prior C-section. The uterus and human body heal surprisingly quickly. By the time you are full-term, your former scar should be more than fully fused. However, depending on the type of scar you have, the amount of weight you gain and the position of the babies near the end of your third trimester, you may end up with another Cesarean delivery.
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Q. I'm 32 weeks pregnant. Is it safe to have an elective C-section? How many weeks do you have to be in order to be eligible?
-LaTonya, Alabama
A. No surgery is ever considered "safe." There are always some risks involved. A Cesarean is major surgery that has the potential to cause excessive blood loss, infection, vein thrombosis, bowel and bladder damage and fetal respiratory distress. And, the recovery period for C-sections is usually much longer than for vaginal delivery. I gave birth both ways, and I strongly recommend the vaginal way if you can.
These days, some women are opting to have an elective C-section to avoid possible incontinence and prolapse problems for which they may be genetically predisposed. Another common reason for an elective Cesarean is to avoid problems with vaginal delivery experienced in a prior delivery. My friend Nancy went through a horrific 29-hour labor and had excessive vaginal tearing with her first. Her second daughter was an elective C-section.
Most elective C-sections are preformed between 37 to 40 weeks, depending on the reasons for the surgery. You should discuss your options with your doctor. If your reasons for the surgery are purely for convenience, your doctor may not comply with your decision.
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