Saturday April 20, 2019

Once a Cesarean, Always a Cesarean; Is Not True Anymore Say Medical Experts

Kapila said that it is the patient's decision that gets greater priority.

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Pregnancy, Breast Cancer
High blood pressure, which had long been defined as a top reading of at least 140 or a bottom one of 90, dropped to 130 over 80 under guidelines adopted in 2017.

It is said that “once a cesarean, always a cesarean”. It is commonly believed that a woman who has undergone a c-section delivery will have to opt for the same method while giving birth to her next child. But medical experts are trying to dispel this myth.

According to them, Vaginal Birth After Cesarean, commonly termed as VBAC, can be adopted by any mother for her second or third birth if she wishes to avoid the complications of c-section delivery.

“Any woman with a previous caesarean section can attempt a VBAC. The majority of women, despite having a c-sect delivery, often prefer a vaginal delivery. Women are showing more courage towards this. It is safe and the established hospitals are providing full support to mothers who plan to go for a vaginal delivery,” Dr Mukta Kapila, Director, Obestrics and Gynaecology, at Fortis Gurgaon, told IANS.

Dr Rinku Sengupta, who had been associated with the Sitaram Bhartia Institute of Science and Research as Maternity Programme Head, said that in recent times two out of three women with a previous c-section deliveries attempt a VBAC and almost 90 per cent of them are successful.

pregnant, cesarean
However, when it comes to vaginal delivery, the first thought that crosses most women’s’ minds is of the labour pain which develops a fear of the VBAC, Pixabay

“Only pregnant women above the age of 40 are more at risk for stillbirths and unsuccessful VBACs. Careful consideration should be given to the timing of delivery in these cases,” Sengupta said.

Sengupta explained that obesity is also a factor that could potentially increase the risk of uterine rupture and this can be a limitation for VBAC. She also pointed to a study that 85 per cent of normal weight women (BMI 18.5-24.9) achieved successful VBAC, while only 61 per cent of morbidly obese (BMI 40 or more) women achieved VBAC.

Kapila said that before opting for a VBAC, the history of the previous delivery needed to be considered.

“Under which conditions and circumstances, a caesarean was conducted — in emergency or breach — first needs to be identified. The mother, planning for vaginal delivery, should at least maintain a minimum gap of two years before opting for the second or third child,” she stated.

Often c-section delivery leaves a scar in the uterus, which, according to the medical experts, is a vital factor to be considered before they suggest a VBAC.

pregnant, cesarean
The baby girl was born through Caesarean section in a government hospital in Karnataka. Image source: Prakash Hassan, BBC

According to the American Congress of Obstetricians and Gynecologists (ACOG), some uterine scars (such as vertical scars which are now rare) are more likely than others to cause a rupture during VBAC.

“Therefore, it is important to show medical records of prior cesarean delivery so that doctors can assess viability for a VBAC in case of increased risk of uterine rupture.Sometimes women are discouraged from trying for a VBAC because of a thin scar,” Sengupta noted.

However, when it comes to vaginal delivery, the first thought that crosses most womens’ minds is of the labour pain which develops a fear of the VBAC.

“Everyone knows that labour is painful and even an epidural injection cannot make labour 100 per cent pain-free. But with proper physical and emotional support, continuous one-on-one presence of a skilled care provider or birth partner, and use of natural methods like warm showers, massages and exercises, most mothers cope very well with labour pain,” Sengupta explained.

Also, the fear of labout pain, according to the experts, can be dispelled by timely counselling and talking about the benefits and less risk involved in VBAC.

Consumption of even one or two cups of coffee per day by expectant mothers can put their babies into a higher risk of being obese at school age.
A Pregnant Woman, Pixabay

Yet, there is always the chance that a VBAC might be called off at the last moment even if the mother didn’t face any complications during pregnancy.

“A doctor may suggest an emergency c-section if complications occur during labour. If the baby is not able to tolerate labour or the contractions aren’t effective in moving the baby down the birth canal, then a cesarean may be the best way to deliver the baby,” Sengupta explained.

Also Read: Anaemia During Pregnancy Might Spike Up Risk of Heart Disease

Kapila said that it is the patient’s decision that gets greater priority.

“There is no point in pushing a mother for VBAC if she is not mentally prepared or feels scared or delivery complications arise at the last moment. Although the doctors will recommend vaginal birth, the patient’s life cannot be put at risk,” Kapila said. (IANS)

Next Story

New York City’s Mandatory Measles Vaccination Order Stands Still

The health department's lawyers argued that quarantining was ineffective because people carrying the virus can be contagious before symptoms appear.

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measles
Materials are seen left at demonstration by people opposed to childhood vaccination after officials in Rockland County, a New York City suburb, banned children not vaccinated against measles from public spaces. VOA

Brooklyn judge on Thursday ruled against a group of parents who challenged New York City’s recently imposed mandatory measles vaccination order, rejecting their arguments that the city’s public health authority exceeded its authority.

In a six-page decision rendered hours after a hearing on the matter, Judge Lawrence Knipel denied the parents’ petition seeking to lift the vaccination order, imposed last week to stem the worst measles outbreak to hit the city since 1991.

The judge sided with municipal health officials who defended the order as a rare but necessary step to contain a surge in the highly contagious disease that has infected at least 329 people so far, most of them children from Orthodox Jewish communities in the borough of Brooklyn.

Another 222 cases have been diagnosed elsewhere in New York state, mostly in a predominantly ultra-Orthodox Jewish neighborhood of Rockland County, northwest of Manhattan.

The New York outbreaks are part of a larger resurgence of measles across the country, with at least 555 cases confirmed in 20 states, according to the U.S. Centers for Disease Control and Prevention.

Health experts say the virus, which can cause severe complications and even death, has spread mostly among school-age children whose parents declined to get them vaccinated. Most profess philosophical or religious reasons, or cite concerns — debunked by medical science — that the three-way measles-mumps-rubella (MMR) vaccine may cause autism.

The judge rejected the parents’ contention that the vaccination order was excessive or coercive, noting it does not call for forcibly administering the vaccine to those who refuse it.

He also dismissed assertions in the petition disputing the “clear and present danger” of the outbreak. “Vaccination is known to extinguish the fire of contagion,” the judge said.

FILE PHOTO: A sign warning people of measles in the ultra-Orthodox Jewish community of Williamsburg in New York City, April 11, 2019.
A sign warning people of measles in the ultra-Orthodox Jewish community of Williamsburg in New York City, April 11, 2019. VOA

Secret identities

The vaccination order, which was extended this week, requires residents of certain affected Brooklyn neighborhoods to obtain the MMR vaccine unless they can otherwise demonstrate immunity to measles, or face a fine.

The court challenge was brought in Brooklyn’s Supreme Court by five people identified only as parents living in the affected neighborhoods. Their identities were kept confidential to protect their children’s’ privacy, their lawyers said.

In court on Thursday, they told Knipel the city had overstepped its authority and that quarantining the infected would be a preferable approach.

Robert Krakow, an attorney for the parents, estimated that just 0.0006 percent of the population of Brooklyn and Queens had measles. “That’s not an epidemic,” he said. “It’s not Ebola. It’s not smallpox.”

The health department’s lawyers argued that quarantining was ineffective because people carrying the virus can be contagious before symptoms appear.

vaccination
The vaccination order, which was extended this week, requires residents of certain affected Brooklyn neighborhoods to obtain the MMR vaccine unless they can otherwise demonstrate immunity to measles, or face a fine. Pixabay

The judge cited 39 cases diagnosed in Michigan that have been traced to an individual traveling from the Williamsburg community at the epicenter of Brooklyn’s outbreak.

Also Read: Short-Circuit Likely The Cause of Notre Dame Fire, Claims Police Investigators

The surge in measles there originated with an unvaccinated child who became infected on a visit to Israel, where the highly contagious virus is also running rampant.

The number of measles cases worldwide nearly quadrupled in the first quarter of 2019 to 112,163 compared with the same period last year, the World Health Organization said this week. (VOA)