Posted by My OB said WHAT?!?.
Feb
7
Posted by My OB said WHAT?!?.
The Number One Reason To Have A Repeat Cesarean Is…”
‘There are two reasons for having a repeat cesarean, number one, is that you have already preserved your pelvic floor, incontinence can be a real big issue when you are 60. ” -OB to VBAC mother during a consultation. The number two reason was uterine rupture.
There are 29 comments to this post.
Someone should have told those nuns in that one study that their pelvic floor issues weren’t related to aging, they were related to not having c-sections for their non-existent pregnancies.
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Mistie Reply:
February 7th, 2010 at 4:53 pm
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oh my gosh! I am laughing so hard I am crying!! nuns.. bwahahahahahahaa!!
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Leah Reply:
February 7th, 2010 at 7:11 pm
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Seriously! Nuns! http://journals.lww.com/greenjournal/Fulltext/2002/08000/Prevalence_of_Urinary_Incontinence_and_Associated.4.aspx
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No. 1: By the age of 50, there is no difference in pelvic floor between woman who have had a c-section and those who have had a vaginal birth.
No. 2: 45% of women who experience uterine rupture have never had a c-section, and c-sections can *cause* uterine rupture.
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Jill--Unnecesarean had this to say,
Feb 7, 2010 @ 7:20 am
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Did she sign up for an ERC after that sales pitch?
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I thought traverse babies was a reason for c-section. That and prolapse, pre-eclampsia and breech (so they say).
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Sheva Reply:
February 7th, 2010 at 10:17 am
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And shoulder dystocia, previous cesarean, prolonged labor, to pick the baby’s birthday, and an important golf tournament…
A Cesarean is a major surgery and, while truly a great gift to many mothers, is meant to be used as a last resort in a real medical emergency where there is no other way to save the mother or baby, not as a substitute or a cover up for poor or non-existent training in a particular area (like the Gaskin maneuver or vaginal breech deliveries).
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Violet Reply:
February 7th, 2010 at 10:50 am
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Thanks for adding that. I don’t consider previous cesarean sections and other things as a real reason for one. What are your real reasons for a c-section?
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Sheva Reply:
February 7th, 2010 at 11:15 am
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Cord prolapse (can often be prevented by not breaking the membranes artificially), transverse breech (only after failed attempted versions through medical and natural means – manual version, moxa treatment, visualization, swimming, pelvic tilt, acupressure, acupuncture, Rebozo method), placenta previa, medical reasons that would prevent the mother from laboring or birthing safely (certain heart or liver conditions), and placental abruption.
Other types of breeches can be safely delivered vaginally with an experienced, well trained caregiver.
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Amelia Reply:
February 7th, 2010 at 11:28 am
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Only two others to add: If baby has a medical reason that would prevent him/her from being birthed safely, such as spina bifida; and if there is no caregiver available experienced in breech births. In that case, a c-section (from someone who is experienced doing c-sections) might be safer than a vaginal birth with a caregiver who is *not* experienced in breech births. Sad but true.
(I’m not saying this is the way things *should* be, just the way they are in many places.)
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Alice Reply:
February 7th, 2010 at 8:05 pm
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I wouldn’t consider pre-e in and of itself to be a valid reason for a c-section, unless induction is contraindicated in the mother. Induction of labour should be tried first imo.
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Sheva Reply:
February 7th, 2010 at 8:14 pm
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Truth is, whenever possible there should be some labor before doing the cesarean. Labor itself has benefits to the baby that help with breathing. (Obviously I’m not referring to a situation where the mother or baby has a medical issue that would preclude this.)
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Violet Reply:
February 7th, 2010 at 8:21 pm
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Okay, so what is an induction again?
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Kat Reply:
February 7th, 2010 at 8:47 pm
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Induction is attempting to start labor by artificial means, rather than waiting for labor to begin by the baby’s/mother’s bodies triggering it (Labor is such a complex process we do not know *for sure* all the factors that trigger it naturally).
Pitocin is a synthetic hormone that causes the uterus to contract, and may start labor.
Cervical dilation substances can be applied to the cervix, and may start labor.
If the cervix is already well dilated, and the baby’s head is engaged, breaking the water can trigger labor.
Sometimes herbal remedies are used as well, but any induction method carries risks and should only be used when the benefits outweigh the risk to the mother and baby!
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Good reasons for major abdominal surgery to deliver a baby:
-transverse lie (during labor – e.g. something like a presenting arm)
-major fetal distress
-placental abruption
-uterine rupture (a good reason to avoid induction drugs as they cause significant increases in rupture rates, in scarred and non-scarred uteri)
-full-blown eclampsia
NOT good reasons for a c-section:
-prolonged labor if otherwise reassuring
-too much or too little fluid
-prolonged rupture (in the absence of fever or signs of infection)
-to choose a birthday
-to avoid pelvic dysfunction(evidence suggests that age and pelvic strange, not birth history, is more important)
-fetal size (TRUE cephalopelvic disproportion – babies too big for mom – are vanishingly rare, about 1/2000 births)
Everyone is better off, of course, with a caregiver that knows how to deal with fetal positioning issues. Malpositioned babies can be turned and/or delivered – but it is way more comfortable and safer to know how to deal with position than to section. A good caregiver can help turn or catch a posterior baby, an asynclitic baby, or any other malpositions.
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Violet Reply:
February 7th, 2010 at 11:29 am
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What’s an asynclitic baby?
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Jennifer Reply:
February 7th, 2010 at 2:21 pm
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Asynclitic positioning means that the baby’s head is tilted in the uterus, and thus is not coming straight down the canal. Often, with a knowledgeable practitioner, the baby can be turned. My mom had this issue with me (in addition to possible posterior positioning (?)), and after prolonged labor, a knowledgeable nurse finally recognized what was happening and ended up reaching in to adjust my position and the labor progressed quickly after that (I am pretty sure it was a minor malposition in that case…)
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Nicholas Fogelson, MD Reply:
February 28th, 2010 at 3:51 pm
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Great list, but I’d edit a few things, in my opinion.
placental abruption – a lot of abruptions can be delivered vaginally, and should be if possible. Sometimes there is a fair amount of bleeding but the fetus is doing fine – in those cases we’re better off transfusing blood if necessary and allowing a vaginal delivery. Adding surgical blood loss doesn’t do the mother any favors if the baby can be delivered safely through the vagina. Fetal monitoring is very helpful in these situations.
-full-blown eclampsia – I disagree with this. An eclamptic woman needs to be treated with magnesium and possibly other anti-seizure medications. Once she is stabilized, induction is a reasonable way to go, especially if she has a favorable cervix. With adequate antiseizure coverage repeat seizure is unlikely. Furthermore, the immediate delivery attainable by cesarean doesn’t benefit her greatly, as it takes many days for the risk of repeat seizure to abate. The extra 12-24 hours needed for an induction are a reasonable trade to avoid the morbidity of a cesarean, if the patient is stable enough for it.
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Lovely Labor RN had this to say,
Feb 7, 2010 @ 3:20 pm
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No joke… I saw a bumper sticker the other day that said “Save a vagina, Have a C-section”
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Susan Jenkins Reply:
February 7th, 2010 at 8:00 pm
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I guess ACOG ran out of those “home delivery is for pizza,” bumper stickers to was selling, and has started distributing some equally mindless ones.
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Susan Jenkins Reply:
February 7th, 2010 at 8:01 pm
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I guess ACOG ran out of those “home delivery is for pizza,” bumper stickers it was selling, and has started distributing some equally mindless ones.
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um, he never heard of Kegels?
go back to school, idiot!
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