Special Delivery

A way to reduce risks from repeat C-sections.

When Beth Verman was expecting her first child, she’d worked out a birthing plan with her obstetrician. “I’d be in the hospital for just two days, then go home and be up on my feet again,” the Villanova resident says.

Two weeks before her due date, Verman’s plans for a normal delivery went out the window. “My obstetrician told me my baby was in breach position and would have to be delivered by caesarean section,” she says. “I wasn’t happy about it, but I didn’t have a choice.”

Verman’s “terrific” husband was in the OR when their daughter, Madison, was delivered. During C-sections, spouses are encouraged to attend surgery to support the mother and share in the experience.

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A C-section meant a longer hospital stay, a painful recovery and additional help at home. “After five days in Pennsylvania Hospital, I was home, but I wasn’t allowed to drive or do anything for another 10 days,” says Verman.

Eighteen months later, Verman discussed her second pregnancy with Dr. Joseph Grover at Delaware County Memorial Hospital. “He said there was no reason I couldn’t have a normal delivery. The baby was in the right position, and the choice was up to me.”

Verman opted for VBAC (Vaginal Birth after Caesarean)—and although her second daughter, Sydney, was born six-and-a-half weeks premature, Beth has no regrets. “If anyone has the option, don’t choose C-section,” she says emphatically. “VBAC is easier on the body and recovery.”

Verman credits the hospital with having an excellent neonatal intensive care unit and a top-notch staff. “I thought it was excellent,” she says. “The hospital is very well-equipped, the care I received was personalized, and the staff was beyond cordial.”

Delaware County Memorial Hospital’s Maternity Center delivers 1,400 babies a year and provides the latest technology and services for high-risk births. Midwives aren’t the exception, they’re an integral part of the program, along with private birthing suites and in-home nursing care for new parents and their babies.

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Dr. Barry Jacobson, chairman of the OB/GYN department at Delaware County Memorial Hospital, advises expectant mothers to investigate their institution of choice. Find out their policy on VBAC, and know their C-section rate. The C-section rate at Jacobson’s hospital is 21 percent. “If it’s 50 percent or higher, go elsewhere,” Jacobson says.

All too often, caesarean delivery occurs for reasons other than the health of the mother and infant. “Physicians are sued if they fail to do a C-section, not if they fail to do a vaginal birth. Other motivations include expectant mothers who don’t want to leave their due date to chance, or risk rushing to the hospital at 3 a.m.,” says Jacobson. “The danger of multiple C-sections is that it leaves scars in the uterus. Seventy-five percent of women who’ve had caesarean deliveries could have a successful vaginal delivery in future pregnancies.”

The World Health Organization estimates the average rate of caesarean sections is 15 percent for all developed countries. That figure jumps to 20 percent in the United Kingdom and a staggering 30.2 percent in the United States. Studies show that the high rate of C-sections in our country is in inverse proportion to the need. A married white woman in a private hospital is more likely to have a caesarean delivery than a poorer woman who has not had prenatal care and whose infant is at greater risk.

But while many women opt for C-sections to maintain vaginal tone and avoid the pain of normal labor, others—like Verman—have no choice. The likelihood of breech and multiple births increases with age, as do diabetes, obesity and other medical conditions.

However, the more C-sections a woman has, the greater her risks. According to the National Institutes of Health, these include bowel injury, ICU admissions, post-operative ventilator use and hysterectomy. A study published last year in the Canadian Medical Association Journal found that women who have planned caesareans are at an 18-percent higher risk of cardiac arrest, anesthetic complications, hemorrhage and blood clots. Those who deliver by C-section for their first births are also at a greater risk of experiencing complications with future deliveries, including abnormal presentation, prolonged labor, uterine rupture, preterm babies, low birth weight and stillbirths. And babies born by caesarean sometimes have trouble breathing and may be drowsy from pain medication administered to the mother.

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Contrary to popular belief, the term “caesarean” is unrelated to the famed Roman emperor. It comes from the Latin verb caedere, “to cut.” In ancient Rome, C-sections were used as the last resort to save an infant whose mother was dying. As it turns out, Julius Caesar’s mother not only survived his birth, but also lived another 25 years.

The first recorded instance of a mother surviving a caesarean birth was in 1500. In the late 19th century, the mortality rate for C-sections was 85 percent. With the advent of antibiotics, advances in anesthesia and improved surgical techniques over the last 50 years, caesareans have become more common.

That said, VBAC also is becoming more common. The old rule, “once a caesarean, always a caesarean,” has gone the way of the Little Bo Peep maternity dress. According to Midwifery Today, “VBAC is safer than repeat caesarean, and VBAC with more than one previous caesarean does not pose any increased risk.”

Benefits of VBAC include lower costs (up to $3,000 less), easier breastfeeding, and prevention of infection, surgical complications and fetal injuries. VBAC also results in fewer fetal deaths than elective repeat caesareans. To reduce the risk of C-section, Public Citizen’s Health Research Group in Washington, D.C., recommends that parents interview more than one care provider; tour more than one birth facility; ask about turning the baby and vaginal breech delivery (in a breech situation); don’t go into labor flat on your back (squatting can be helpful); avoid routine use of electronic fetal monitoring, which has been shown to cause an increase in C-sections; and avoid pitocin and epidurals if labor is slow.

VBAC requires more preparation than a C-section delivery. Being in good physical condition helps labor move more quickly and speeds healing. Regular exercise and special birth exercises are a good way to begin. Having access to a midwife and a dedicated birthing center will reduce anxiety and prepare the expectant mother for her first vaginal birth following a caesarean.

It’s also important to be prepared emotionally. At Delaware County Memorial Hospital, the combination of childbirth education classes and midwives on staff allows first-time VBAC patients to feel safe and supported. In fact, many women find the experience of a vaginal birth to be empowering.

Why a C-section?

Labor isn’t progressing.
The most common reason for a C-section.

Baby’s head is too big to pass through the birth canal. Or the cervix isn’t opening enough.

Reduced oxygen supply. The baby isn’t getting enough oxygen during labor.

Changes in baby’s heartbeat. Reduced or erratic during labor.

Abnormal position. If the baby is in breech position and can’t be moved into a more favorable position.

Baby’s head is in the wrong position. If the baby enters the birth canal with the chin up or face leading the way.

Twins or multiple births. It’s common for one or more of the babies to be in an abnormal position.

Placenta problem. If the placenta detaches from the uterus before labor begins, or it covers the opening of the cervix.

Umbilical cord problem. If the cord is compressed by the uterus during contractions, or it slips through ahead of the baby.

Mother has health problems. If the expectant mother has diabetes, heart disease, lung disease, high blood pressure or active genital herpes.

Baby has health problems. If the baby has been diagnosed with spina bifida, hydrocephalus or another condition that creates risk.

Previous C-sections. Women who’ve had previous C-sections should consult their physicians to determine if they’re candidates for vaginal delivery.

Source: mayoclinic.com

VBAC Checklist
1. Read up on the subject.
2. Take a prenatal fitness class.
3. Register for a VBAC prenatal program.
4. Focus on good nutrition.
5. Locate a physician and hospital with a VBAC success rate of more than 75 percent and a low caesarean rate.
6. Hire a midwife.
7. Write a birth plan and give copies to your midwife, physicians and hospital.
8. Attend VBAC support meetings.
9. Seek emotional support from family, friends, healthcare providers and counselors.

Source: childbirth.org

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