Thursday December 13, 2018

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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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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First Successful Case Of Womb Transplant in Brazil

In the Brazilian case, the recipient had been born without a uterus due to a condition called Mayer-Rokitansky-Küster-Hauser syndrome. The donor was 45 and died of a stroke.

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Womb Transplant
Medical team hold the first baby born via uterus transplant from a deceased donor at the hospital in Sao Paulo, Brazil. VOA

A woman in Brazil who received a womb transplanted from a deceased donor has given birth to a baby girl in the first successful case of its kind, doctors reported.

The case, published in The Lancet medical journal, involved connecting veins from the donor uterus with the recipient’s veins, as well as linking arteries, ligaments and vaginal canals.

It comes after 10 previously known cases of uterus transplants from deceased donors – in the United States, the Czech Republic and Turkey – failed to produce a live birth.

The girl born in the Brazilian case was delivered via caesarean section at 35 weeks and three days, and weighed 2,550 grams (nearly 6 lbs), the case study said.

Dani Ejzenberg, a doctor at Brazil’s Sao Paulo University hospital who led the research, said the transplant – carried out in September 2016 when the recipient was 32 – shows the technique is feasible and could offer women with uterine infertility access to a larger pool of potential donors.

Womb
. The woman’s previously fertilized and frozen eggs were implanted after seven months and 10 days later she was confirmed pregnant.. Pixabay

The current norm for receiving a womb transplant is that the organ would come from a live family member willing to donate it.

“The numbers of people willing and committed to donate organs upon their own deaths are far larger than those of live donors, offering a much wider potential donor population,” Ejzenberg said in a statement about the results.

She added, however, that the outcomes and effects of womb donations from live and deceased donors have yet to be compared, and said the technique could still be refined and optimised.

The first baby born after a live donor womb transplant was in Sweden in 2013. Scientists have so far reported a total of 39 procedures of this kind, resulting in 11 live births.

Experts estimate that infertility affects around 10 to 15 percent of couples of reproductive age worldwide. Of this group, around one in 500 women have uterine problems.

Before uterus transplants became possible, the only options to have a child were adoption or surrogacy.

Infants, baby, WOmb
The case, published in The Lancet medical journal, involved connecting veins from the donor uterus with the recipient’s veins. Pixabay

In the Brazilian case, the recipient had been born without a uterus due to a condition called Mayer-Rokitansky-Küster-Hauser syndrome. The donor was 45 and died of a stroke.

Also Read: Pregnancy is Possible For Survivors of Breast Cancer

Five months after the transplant, Ejzenberg’s team wrote, the uterus showed no signs of rejection, ultrasound scans were normal, and the recipient was having regular menstruation. The woman’s previously fertilized and frozen eggs were implanted after seven months and 10 days later she was confirmed pregnant.

At seven months and 20 days – when the case study report was submitted to The Lancet – the baby girl was continuing to breastfeed and weighed 7.2 kg (16 lb). (VOA)