Tuesday February 19, 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

Study Claims, There Should Be Treatment Options Given for Miscarriage

Miscarriage is the most common complication of pregnancy and affects an estimated one in four pregnancies. 

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Miscarriage is the most common complication of pregnancy and affects an estimated one in four pregnancies. Pixabay

Though miscarriage is a traumatic experience for both parents, resulting in feelings of loss and grief that in some cases can lead to anxiety and depression, women experiencing miscarriage should be offered a choice in the treatment they receive, suggests a study.

Miscarriage is the most common complication of pregnancy and affects an estimated one in four pregnancies.

Although guidelines recommend trying to resolve an unsuccessful pregnancy naturally, the new analysis shows that this is only successful in 70 per cent of cases, and potentially comes with complications that are rarely communicated to patients.

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Some women are more keen on having a quick surgical intervention so that they can resume their lifestyle immediately, some are very keen to avoid surgery and prefer to go with a tablet, and others want to take a more natural approach,” Wattar added. Pixabay

The study from the University of Warwick and Queen Mary University of London, demonstrates little to no difference in medical effectiveness in resolving an unsuccessful pregnancy between medical and surgical options.

Thus, the team recommend the doctors to offer women a choice of treatment options for miscarriage to enable them to make an informed decision that takes account of potential uncomfortable side effects, long waiting times and extended periods of recovery.

“What we have to do is provide women with evidence about the benefits and effectiveness of each treatment option and potential side effects so that they can choose what they feel most comfortable with,” said lead author Bassel Wattar from Warwick Medical School.

“Some women are more keen on having a quick surgical intervention so that they can resume their lifestyle immediately, some are very keen to avoid surgery and prefer to go with a tablet, and others want to take a more natural approach,” Wattar added.

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Miscarriage is the most common complication of pregnancy and affects an estimated one in four pregnancies. Pixabay

For the results, published in the journal Human Reproduction Update, the team reviewed 46 trials involving over 9,000 women who experienced spontaneous loss of pregnancy (miscarriage) before 14 weeks gestation.
Also Read: Going Out on a Date? Try These Make-up Looks
During a miscarriage, the body will aim to resolve the unsuccessful pregnancy naturally but conservative treatment can be painful with increased bleeding, increased likelihood of hospital admission, reduced quality of treatment and reduced satisfaction.

However, surgery which include electric vacuum aspiration, and medical treatment with a tablet were found to have similar effectiveness in treating miscarriage as conservative treatment. (IANS)