Tuesday February 25, 2020

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

Here’s Why Diabetes May be an Independent Risk Factor For Heart Failure

Diabetes is also a major risk factor for atherosclerosis and this eventually leads to blockage of coronary arteries

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Disease
According to health expert in India, if poorly controlled, diabetes leads to cardiomyopathy resulting in progressive deterioration of pumping capacity of heart. Pixabay

Heart problems are a common development for people with diabetes and now researchers have found that diabetes is an independent risk factor for the development of heart failure in the community dwelling population.

According to health expert in India, if poorly controlled, diabetes leads to cardiomyopathy resulting in progressive deterioration of pumping capacity of heart.

“Diabetes is also a major risk factor for atherosclerosis and this eventually leads to blockage of coronary arteries. This leads to heart attack or myocardial infarction,” Satish Koul, HOD and Director Internal Medicine, Narayana Superspeciality Hospital, Gurugram, told IANS. “Due to myocardial infarction, the heart muscle becomes weak and eventually heart fails as a pump leading to congestive heart failure,” Koul added.

According to the current study, published in the journal Mayo Clinic Proceedings, researchers evaluated the long-term impact of diabetes on the development of heart failure, both with preserved ejection fraction – a measurement of the percentage of blood leaving the heart with each contraction – and reduced ejection fraction.

They also looked at mortality in a community population, controlling for hypertension, coronary artery disease and diastolic function. From an initial group of 2,042 residents of Olmsted County in US, 116 study participants with diabetes were matched 1:2 for age, hypertension, sex, coronary artery disease and diastolic dysfunction to 232 participants without diabetes.

Over the 10-year follow-up period, 21 per cent of participants with diabetes developed heart failure, independent of other causes. In comparison, only 12 per cent of patients without diabetes developed heart failure. Cardiac death, heart attack and stroke were not statistically different in the study between the two groups.

The study shows that diabetes is an independent risk factor for the development of heart failure in the community dwelling population. Furthermore, the outcome data support the concept of a diabetic cardiomyopathy.

Heart Disease
Heart problems are a common development for people with diabetes and now researchers have found that diabetes is an independent risk factor for the development of heart failure in the community dwelling population. Pixabay

This research extends previous findings and demonstrates that even without a known cardiac structural abnormality and with a normal ejection fraction, diabetic patients are still at increased risk of developing heart failure as compared to their nondiabetic counterparts.

“The key takeaway is that diabetes mellitus alone is an independent risk factor for the development of heart failure,” said study senior author Horng Chen from Mayo Clinic in the US.

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“Our hope is that this study provides a strong foundation for further investigations into diabetes and heart failure. There is still much to learn and study in terms of this association and how to best diagnose and treat this condition,” Chen added. (IANS)