Sunday July 21, 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: Intake of Dietary Supplements May do More Harm than Benefit

The doctor suggested that people should include more green vegetables in their diet

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dietary supplements
According to the study published in the journal Annals of Internal Medicine, supplements combining calcium and vitamin D may be linked to a slightly increased stroke risk. Pixabay

Researchers have found that intake of some vitamins, minerals and other dietary supplements may not benefit the heart and, in some cases, may even prove to be injurious.

According to the study published in the journal Annals of Internal Medicine, supplements combining calcium and vitamin D may be linked to a slightly increased stroke risk. However, there was no evidence that calcium or vitamin D taken alone had any health risks or benefits.

“Our analysis carries a simple message that although there may be some evidence that a few interventions have an impact on death and cardiovascular health, the vast majority of multivitamins, minerals and different types of diets had no measurable effect on survival or cardiovascular disease risk reduction,” said study lead author Safi U. Khan, Assistant Professor at the West Virginia University.

For the study, the researchers used data from 277 randomised clinical trials that evaluated 16 vitamins or other supplements and eight diets for their association with mortality or heart conditions including coronary heart disease, stroke and heart attack.

dietary supplements
“People should focus on getting their nutrients from a heart-healthy diet, because the data increasingly show that the majority of healthy adults don’t need to take supplements,” Michos said. Wikimedia Commons

They included data gathered on 992,129 research participants worldwide. The analysis showed possible health benefits only from a low-salt diet, omega-3 fatty acid supplements and possibly folic acid supplements for some people.

“The panacea or magic bullet that people keep searching for in dietary supplements isn’t there,” said senior author of the study Erin Michos from Johns Hopkins University School of Medicine in the US.

“People should focus on getting their nutrients from a heart-healthy diet, because the data increasingly show that the majority of healthy adults don’t need to take supplements,” Michos said.

According to Abhishek Singh, Consultant Cardiologist at Columbia Asia Hospital in Ghaziabad, dietary supplements do not have a measurably positive impact on cardiac health.

dietary supplements
The doctor suggested that people should include more green vegetables in their diet. Pixabay

“It’s more important to follow a healthy dietary regimen and avoid foods that are bad for the heart. Trans fatty acids are harmful and have to be curtailed. Refined sugars and simple carbohydrates are to be kept at a minimum,” Singh told IANS.

The doctor suggested that people should include more green vegetables in their diet. They are rich in vitamin K and dietary nitrates, which help protect the arteries and reduce blood pressure, he said.

ALSO READ: Fatal Drug Overdoses Decline in US; First Drop in Two Decades

“Studies like this raise concerns about harm from calcium and Vitamin D supplement use. As far as Vitamin D supplements (without calcium) are concerned, there has been no evidence on whether it has any impact on cardiovascular disease risk reduction,” Anupama Singh, Senior Consultant, Internal Medicine at Vimhans Nayati Super Specialty Hospital in Delhi, told IANS.

“The quality of the evidence base of these various nutritional supplements and dietary interventions still needs to be evaluated to ascertain the effectiveness of the study,” she added. (IANS)