Monday November 18, 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)

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Report: Express Grieving Conditions for Sanitation Workers in Developing Countries

Authors of the report say sanitation workers in developing countries largely operate in the informal sector

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Developing Countries
Sanitation workers are the people who work in jobs such as cleaning toilets, emptying pits and septic tanks, cleaning sewage and manholes and operating pumping stations and treatment plants, but their Condition is not good in Developing Countries. Wikimedia Commons

A new report by leading health and safety agencies finds millions of sanitation workers in Developing Countries are forced to work under horrific conditions that put their health and lives at risk.

Sanitation workers everywhere occupy the lowest rung of society and are stigmatized and marginalized because they do the dirty work that other people do not want to do.

The report’s authors – the International Labor Organization, the World Health Organization, the World Bank and Water Aid – say they hope to raise awareness on the plight of sanitation workers and the dehumanizing conditions under which they are forced to work. For example, the report says that many sanitation workers aren’t given the safety training or equipment needed to protect them when handling effluent or fecal sludge.

World Health Organization spokesman Christian Lindmeier says sanitation workers make an important contribution to public health at the risk of their own lives. Poor sanitation, he says, causes more than 430,000 deaths from diarrhea every year and is linked to the spread of other diseases such as cholera, dysentery, typhoid, hepatitis A and polio.

“Sanitation workers are the people who work in jobs such as cleaning toilets, emptying pits and septic tanks, cleaning sewage and manholes and operating pumping stations and treatment plants.… Waste must be correctly treated before being disposed of or used. However, workers often come into direct contact with human waste, working with no equipment or no protection to remove it by hand which exposes them to a long list of health hazards and diseases,” Lindmeier said.

Developing Countries
A new report by leading health and safety agencies finds millions of Sanitation Workers in Developing Countries are forced to work under horrific conditions that put their health and lives at risk. VOA

Authors of the report say sanitation workers in developing countries largely operate in the informal sector. They labor under abusive conditions, have no rights or social protections and are poorly paid.

ALSO READ: WHO Demands Strict Regulations on Vaping Products

The study calls on countries to rectify these wrongs. It urges governments to enact laws and regulations that improve working conditions for sanitation workers and protect their safety and health. It says sanitation workers must be given the equipment and training necessary for the safe, proper disposal of waste. (VOA)