Tuesday February 18, 2020

Is Vaginal Delivery Better Than Cesarean Birth? Find it Out Here

Opt for a vaginal birth or cesarean delivery?

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Birth
There are several factors which come into play for a vaginal delivery/ birth--if there are no medical or pregnancy related complications. Pixabay

There is a raging debate regarding the pros and cons of a vaginal delivery versus a cesarean birth. A lot has been said about the alarming rise in the incidence of so called unindicated cesarean births in corporate hospitals. Dr Uma Vaidhyanathan, Fortis Hospital, Shalimar Bagh talks about the details of both so you’re better informed.

Being an obstetrician in clinical practice for several years now and having seen both sides, PDr. Vaidhyanathan can safely opine it varies from case-to-case and from patient-to-patient!

“There are several factors which come into play for a vaginal delivery–if there are no medical or pregnancy related complications, the baby size is adequate enough to negotiate through the maternal pelvis, and most importantly, if the mother to be is well tuned for labour pains then nothing better than a vaginal delivery. For this the mother should be well counselled throughout the pregnancy about stages of labour, and should be mentally prepared to go through it. It helps if she has a supportive partner and family to boost her morale throughout the process of labour and delivery. It is definitely more natural, recovery and the period of staying in the hospital is definitely shorter,” confirms Dr Vaidhyanathan.

Child Birth
A lot has been said about the alarming rise in the incidence of so called unindicated cesarean birth in corporate hospitals. Pixabay

She also states that, “early contact with the baby, early establishment of breastfeeding and natural squeezing out of fluid from the lungs of the baby reduces chances of distress. The return to normal life and normal physical activity, too, is undoubtedly faster for the mother. Some issues that may present themselves with vaginal birth are tears in the vagina during the passage of the baby during birth which may need stitches. Without stitches, the tearing can negatively affect urine and bowel function which happens more frequently after vaginal birth. A vaginal birth may leave the mother with some pain in the perineum – the area between the vagina and anus.”

With regards to a cesarean delivery, the doctor feels, “at times, a cesarean delivery becomes necessary if the mother has a complication such as severe hypertension, twin or triplet pregnancy or placenta related complications. The complications can be a low lying placenta, abnormal position of the baby in utero such as breech or transverse lie, severe growth restriction in the baby wherein the baby may not be able to tolerate the stresses of a vaginal birth or the baby may be too big for the maternal pelvis!”

She also confirms that a cesarean may be unplanned, “especially in cases where there is a sudden dip in the baby’s heart rate during labor or if labour is prolonged beyond acceptable international guidelines for the various stages of labor. In such cases a well-planned cesarean birth does help saving both the mother and the baby in a well-equipped set up.”

But what are the disadvantages of a cesarean? “The disadvantages of a cesarean are increased length of hospital stay, discomfort in stitch line that may last weeks or months, higher risk of blood loss and infection, increased risk of a cesarean delivery in a future pregnancy as well as increased risk of placental abnormalities. These days though, with shorter surgical times, better suture materials and good antibiotics and stringent infection control practices in hospitals and good physiotherapy and lactation support post-delivery, we see patients getting mobilized as early as 6-12 hours post cesarean and seeking early discharge within 48-72 hours,” she replies.

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All in all, a lot depends on counseling, mental preparedness and how comfortable the mother to be is with both modalities of birthing. Every prospective parent should have a detailed discussion with their obstetrician regarding their pregnancy, possible complications and options for birthing and pain relief available. Both modalities have their distinct advantages and disadvantages in select cases, and a well conducted delivery in which both the mother and baby go home safely, is what every obstetrician aspires for! (IANS)

Next Story

Reflux Drug Can Be a Promising Therapy To Curb Preterm Birth: Study

The researchers identified 83 drug candidates, but when they excluded those found to have pregnancy risks in animal or human studies

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Pregnancy
Inflammation clearly plays a role in initiating labour and preterm birth. Immune pathways are very significantly dysregulated in women who end up delivering preterm, and they're also dysregulated in babies who are born early. Pixabay

Researchers have found that Lansoprazole, an over-the-counter acid reflux drug that is often taken by pregnant women, may be a promising therapy to reduce preterm birth.

The study, published in the journal JCI Insight also identified 12 other USFDA-approved drugs that are deemed safe in pregnancy. While the drugs encompass a variety of modalities, the researchers said they all appear to act on biological pathways that affect the immune response, which is implicated in preterm birth.

“Inflammation clearly plays a role in initiating labour and preterm birth. Immune pathways are very significantly dysregulated in women who end up delivering preterm, and they’re also dysregulated in babies who are born early,” said said study senior author Marina Sirota from University of California.

“However, we have seen from our previous work that there is an interaction between the maternal and fetal immune systems and a breakdown in maternal-fetal tolerance,” Sirota added. To identify candidate drugs that might be effective in preventing preterm birth, the researchers first looked at which genes were up- or down-regulated in the blood cells of women who experienced spontaneous preterm birth to identify a gene expression “signature.”

Then they looked for the opposite signature in cells that had been exposed to 1,309 different drugs, reasoning that if a drug could correct the effects that preterm birth had on the women’s blood cells, the drugs might also prevent preterm birth itself.

The researchers identified 83 drug candidates, but when they excluded those found to have pregnancy risks in animal or human studies, they wound up with 13 drugs, ranked according to their “reversal score,” a measure of the extent to which they were able to reverse the gene expression signature of preterm birth.

The scientists chose lansoprazole for further testing because, in addition to its high reversal score, it is available over the counter, and they know from their previous work that it affects a stress-response protein, heme oxygenase-1, that has been linked with pregnancy disorders.

Lansoprazole, which is a proton-pump inhibitor marketed as Prevacid, had the second-highest reversal score of the 13 drugs identified as being safe and effective. Progesterone was further down the list. The researchers tested lansoprazole in pregnant mice that had been given a bacterial component to induce inflammation, which causes some fetuses to die in utero, where they are reabsorbed.

Pregnancy
Researchers have found that Lansoprazole, an over-the-counter acid reflux drug that is often taken by pregnant women, may be a promising therapy to reduce preterm birth. Pixabay

When these mice were given lansoprazole, they had more viable fetuses. Lansoprazole also worked better in these mice than progesterone. Although it is a good measure of how inflammation affects pregnancy in mice, the researhers said the fetal resorption mouse model is not an adequate model of human preterm birth.

They said more work, including studies in people, would need to be done before lansoprazole or any of the dozen other drugs they identified could be proven effective in pregnant women at risk for preterm birth.

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“This, basically, is a proof of concept that this drug has anti-inflammatory properties, which are not the properties the drug was designed for, this is a short way to get to new therapeutics for known diseases,” said study author David K Stevenson. (IANS)