Pregnancy, Babies, and Birth: Cesarean Birth

My previous blog post focused on the stages of labor, specifically what to expect during a typical vaginal delivery.  Today we look more closely at what happens during Cesarean births, more commonly known as C-sections.  A C-section is when a baby is delivered through a surgical incision made in the mother's abdomen.  Since this is major abdominal surgery, a qualified OB/GYN (or other surgeon) must perform the delivery and will require the mother to be placed under either regional anesthesia or general anesthesia (general is used usually only in rare cases--see our post on pain management during birth).

When is a C-section necessary?

Some women, or their physicians, opt for a planned C-section delivery for several reasons.  One of the most common reasons is that the woman has had previous C-sections and requires additional C-section deliveries for all subsequent births.  If a woman had a C-section with her first birth, most major hospitals will allow her to try for a VBAC (vaginal birth after cesarean) if she desires, but after two C-section births, each subsequent baby will need to be delivered by Cesarean as well.  The reason for this is that each time an incision is made into the uterus, the risk of uterine rupture during a vaginal delivery increases.  So, in order to provide for the safety of mom and baby, C-sections are completed for every birth after two previous Cesareans.  Other reasons a woman may need to deliver via elective C-section are if she is carrying multiples (some twins can be born vaginally, but any more than two babies, C-sections are most common), if the baby is too large to fit through the mother's pelvis, if the baby is breech (either laying sideways, feet first, or bum first instead of head down), if the mother has placenta previa (where the placenta is partially or completely covering the opening of the cervix which will render vaginal delivery impossible), and occasionally for convenience or control over the baby's due date.

Aside from elective C-sections, Cesarean deliveries may become necessary if unforeseen complications arise during a vaginal delivery.  Some of these complications include failed induction, stalled labor that is unresponsive to further stimulation, if the baby shows signs of distress (such as continual drops in heart rate) that cannot be resolved by changing positions or giving the mother oxygen, if the umbilical cord comes out first (which can cut off your baby's blood and oxygen supply), if the placenta becomes prematurely detached from the uterine wall (results in cutting off baby's oxygen supply), or other signs of danger to either mother or baby if a vaginal delivery is continued.  Your doctor will make you aware of any potential need for a C-section and should spend as much time as the situation allows talking to you about why it may be necessary and what a C-section means for you and your baby.  Feel free to ask about potential risks and benefits of a C-section for your particular circumstance.


What happens during a C-section?

If a C-section is deemed necessary or you elect for one, your will be asked to sign a consent form and your doctor or nurse will be available to answer any questions you might have about the procedure.  An anesthesiologist will then come talk to you about pain management options; most likely you will be given a spinal block or epidural.  Because you will be made completely numb, a catheter will be placed in your urethra to drain your bladder until you can get up and walk again after the surgery is over.  For the most part, your partner or one support person will be allowed to stay in the operating room with you, but sometimes they may not be allowed into the room until you are completely prepped and ready for surgery.  In extreme emergency situations, your partner may not be able to accompany you because time is of the essence.

Once prep is over and you are totally numb, a screen will be raised at your waist so you won't be able to see the surgery.  Your arms may be strapped down during the surgery, but don't be alarmed, this isn't always the case.  Procedures may differ from hospital to hospital and from doctor to doctor.  If you are panicky or the surgery is an emergency, they may strap your arms to the arm boards.  Otherwise, they may just have you place your arms down on the arm boards and ask you to keep them there without any straps.  Your partner will be given a chair to sit at next to your head, but is usually welcome to peek over the drape if he wishes.

  

During the actual surgery, the doctor will spread an antiseptic solution over your stomach to clean the area.  Then, he/she will make a relatively small cut right above your pubic bone, then continue cutting down through the layers of fat and tissue until he/she reaches the muscles.  Your doctor will usually separate your muscles and move them out of the way manually rather than cut them.  Once he/she reaches your uterus, he/she will typically make a small, horizontal incision in the uterine wall (sometimes a vertical incision is made if your baby is very premature or the uterus isn't thinned out enough).  Your doctor will then remove your baby, clamp and cut the umbilical cord, then hand baby off to one of the nursing team.  If you would like, they can lower the screen a little for you to see the actual delivery or they can show you baby over the screen after delivery before he/she is taken to be cleaned and evaluated.  Your doctor will then deliver the placenta and start the process of closing up your incisions.  Disolvable stitches will be used for any internal closings and then either stitches or staples will be used to close up the skin incision.

Given that your baby is in good health, he/she will be wrapped in a blanket and given to dad or your support person, who can hold baby next to your head while the doctor finishes stitching you up.  If baby needs some extra help, he/she may be taken to the nursery or the Neonatal Intensive Care Unit (NICU).  After your are stitched up, you will be taken to a recovery room and monitored for a few hours.  If baby is healthy, you can keep him/her with you and try to breastfeed if you wish.  A C-section will require you to stay in the hospital a few days longer than a regular vaginal delivery so they can monitor you and keep an eye on how your incision is healing.  Recovery can take longer and you will have to be very mindful of keeping your incision clean and watching for any signs of infection.



Source: www.babycenter.com



Disclaimer: The "Pregnancy, Babies, and Birth" blog series is meant as a source of general information only.  It's intended use is to encourage women to further consider and discuss reproductive and birthing decisions themselves, with their partners, and with their medical care providers.  Information included in this series is not intended to be professional medical advice or a substitution for a relationship with a licensed physician or practitioner.  Any serious questions or concerns about reproductive, prenatal, and/or perinatal health should be directed to your primary care physician or other licensed specialist.  Women's Services and Resources does not promote any particular brand, medical provider, birthing location, or any other specific birthing decisions.  We strongly encourage women to become as educated about their choices as possible so they are empowered to make educated decisions for themselves and their babies. ADSENSE HERE

Pregnancy, Babies, and Birth: Childbirth Classes

One of the most anxiety-provoking aspects of giving birth to your first child is not knowing what to expect.  For this reason, it's a great idea for all new expectant moms and their partners to take a childbirth class.  There are several different kinds of classes that parents can take:

• General Childbirth Class/Prenatal Class: Most hospitals offer a general childbirth class that covers hospitals policies and procedures (like being admitted when you're in labor), discomforts of late pregnancy, stages of labor, recovery, some breathing and relaxation techniques, breastfeeding support, postpartum care, and infant care.  These classes usually don't teach a specific method of childbirth (like lamaze or Bradley).  Most hospitals will also give you a tour of the labor and delivery unit, the Neonatal Intense Care Unit (NICU), and the mother/infant recovery unit so you can become better acquainted with the hospital you will be delivering at.

• Lamaze Class: These classes focus on the philosophy that birth is a natural event and that women should be free to progress through the process of labor without medical intervention, should they choose to do so.  If you want to have a natural birth, free of medication, a lamaze class is a good option for you.  They will teach certain breathing and distraction techniques to help mom manage pain during labor.  There is also a focus on empowering women to make informed decisions about labor and birth, including what to expect if certain medical interventions need to be performed.

• The Bradley Method: Similar to the lamaze philosophy, the Bradley Method teaches that birth is a normal and natural process and that with proper education and preparation, most women can give birth naturally.  This method highlights the importance of the husband/partner as an active coach throughout the labor process.  Through the means of proper nutrition and exercise during pregnancy, and a combination of education, breathing, and relaxation, the Bradley Method advocates for medication-free birth.  This method is taught by certified instructors and usually lasts about 12 weeks.

• Hypnobirthing Classes: These classes teach women to use deep relaxation and visualization techniques in addition to self-hypnosis, to manage pain during labor and create a calm, comfortable, and serene birth experience.  While these techniques are often used for women who want to have a natural birth free of pain medications, it is also used for women who do choose pain medication or have to have other medical interventions during labor. 

• Other Classes: Prenatal Yoga has become increasingly popular as it is something you can practice throughout your pregnancy (from formal classes to DVDs you can do at home) and that you can modify to accommodate the different stages of your pregnancy.  The breathing, stretching, and meditation techniques (including kegel exercises) can help prepare mothers for the birthing process.  There are a variety of other options using lesser known birthing techniques.  However, because they are less well known, they may not be as widely available in your area as the classes listed above.  Some of these include Birthing From Within, BirthWorks, the Alexander Technique, etc.

How to Find a Childbirth Class in your area

You can take a variety of prenatal classes from area hospitals or from private providers in your community.  Utah Valley Regional Medical Center, for example, offers 1-day breastfeeding classes, 4-week lamaze classes, and prenatal classes (4-week, 2-week, or 1-day).  Husbands/birth coaches are encouraged to attend all prenatal classes (yes, even breastfeeding classes) with the expecting mom so they know what to expect and can be a good support and advocate for mom during labor and delivery.  If you know what type of class you would like to take and it isn't offered by your local hospital or birthing center, type the name of the class and your location into a search engine to find a class in your area.  For people with limited funds or tight schedules, there are also online birth classes offered through websites like BabyCenter.com that are taught through video clips and reading excerpts.

Sources: www.babycenter.com, www.lamaze.org, www.bradleybirth.com



Disclaimer: The "Pregnancy, Babies, and Birth" blog series is meant as a source of general information only.  It's intended use is to encourage women to further consider and discuss reproductive and birthing decisions themselves with their partners and with their medical care providers.  Information included in this series is not intended to be professional medical advice or a substitution for a relationship with a licensed physician or practitioner.  Any serious questions or concerns about reproductive, prenatal, and/or perinatal health should be directed to your primary care physician or other licensed specialist.  Women's Services and Resources does not promote any particular brand, medical provider, birthing location, or any other specific birthing decisions.  We strongly encourage women to become as educated about their choices as possible so they are empowered to make educated decisions for themselves and their babies. ADSENSE HERE

Pregnancy, Babies, and Birth: Choosing a Birthing Location

As with choices in healthcare providers, women have several choices in terms of where they would like to deliver their babies.  Almost all of women in the U.S. (about 99%) give birth in a hospital setting; meaning less than 1% of women choose to give birth in a Birthing Center or at home.  Choosing a birthing location is a very important personal choice.  We highly encourage you to discuss your options in depth with your healthcare provider and do your research in terms of the pros and cons of delivering at each of the following locations.  Remember, the most important aspect of delivering your baby is the health and safety of both you and your child.  If you are realistic and flexible in your expectations and birth plan (see our upcoming post about birth plans), you're likely to have a less stressful experience.  Following are several pros and cons for giving birth in the three different locations.  The lists are by no means exhaustive, but give you a good idea of what can be expected from giving birth in each place.

Hospital

     Pros:
          1. Immediate access to trained medical professionals.  All you have to do is push a button and a L&D nurse is right at your bedside.  Additionally, if your doctor has a hard time getting to the hospital, there are other doctors on staff at the hospital that can attend to your birth.
          2. Consistent, if not constant, monitoring of your vitals and your baby's vitals.  Some states mandate which healthcare providers can and cannot use certain monitoring technologies during birth.  At a hospital, all monitoring techniques can be used by trained professionals.
          3. Immediate access to advanced medical technologies and facilities.  Should complications arise, or should you choose to have a medicated birth, the necessary professionals, tools, facilities, and medications are available at your fingertips in a hospital.
          4. It is the safest environment for high risk pregnancies to deliver.  Mothers with high risk pregnancies should only give birth in a hospital in order to maintain the health and safety of themselves and their baby or babies.
          5. Anesthesiologists are on staff to deliver pain medication during labor should you choose medicated birth.  Only certain trained professionals can administer pain medications like epidurals and other meds.
          6. Close monitoring of you and your baby's health after delivery.  Nurses and doctors will monitor both of your recoveries and your baby will even get his/her first visit from a pediatrician.
   
      Cons:
          1. Can seem impersonal and intimidating, especially larger hospitals with lots of staff.
          2. The constant coming and going of staff takes away an aspect of privacy and may interrupt your resting time.
          3. Some hospitals have shared rooms, so you may need to share with another mother, her baby, and whoever else she may want to visit her/stay with her.
          4.  Your newborn will be monitored frequently, so the staff may take him/her away more frequently to run tests or screenings than you would like.
          5. You will be bound to some hospital policies and procedures that you otherwise wouldn't be if you give birth at home.  For example, visiting hours, restriction of certain visitors (very young children that aren't siblings of the newborn), and not being able to eat during labor (in case of a c-section).
          6. High cost.  Starting at $6,000 for an uncomplicated vaginal delivery up to $20,000 for a c-section. If you have good insurance, it will cover most of the expense, but if you are paying out of pocket, the price can seem pretty unmanageable.

Birthing Center

     Pros:
          1. More comfortable, home-like environment than most hospital settings.  Although some hospitals are moving more towards comfortable environments, birthing centers specialize in creating a home-like atmosphere.
          2. Most are affiliated with a hospital nearby, so they have a tried-and-true method of transferring should the need arise.  Some birthing centers are even in the same medical complex, making a transfer quick and relatively easy.
          3. Generally cheaper than a hospital birth (around $5,000 depending on the birthing center).  If cost is a factor for you, a birthing center may offer a more feasible opportunity with medical professionals on hand and a more structured environment.
          4. More likely to focus on natural birthing methods like birthing balls, tubs, and other natural ways of managing pain during labor.  If you are aiming to have a natural birth, birthing centers will be a great environment to help you stay on track with your hopes for natural means of handling pain.
          5. If the birth goes well, some will offer you to leave the birthing center within a few hours after birth.  If you want to be home soon after, they can discharge you fairly soon so you can recover in the comfort of your own home.
    
     Cons:
          1. You will not have the option of getting an epidural or more intense methods of pain management (some birthing centers may offer mild narcotics).
          2. If you are at a birth center that is not affiliated with a hospital, it could be a while before you are transferred if complications arise.
          3. Lack of all medical technology and equipment available in hospitals.
          4. Make sure the birthing center you choose adheres to proper regulations, has insurance, and has guidelines for practice.  Some freestanding birthing centers do not and, therefore, have no one that they report to in case of mishandling of birth.
          5. While birthing centers are generally safer than delivering at home, they are still not as safe as delivering in a hospital when complications arise.

Home

     Pros:
          1. The birth occurs in a familiar, comfortable environment.
          2. Lower rates of medical interventions like C-sections and episiotomies.
          3. Generally a safe alternative for healthy, low-risk mothers that have had adequate prenatal care with the assistance of a licensed midwife.
          4. There are no limitations to who can attend your birth or visit you during your recovery.
          5. You have the most control and privacy during a home birth.
          6. Cheapest option out of the three.  The only costs that you will be covering are the midwife and any other professionals that you have attend the birth (like a doula or midwife's assistant).
   
     Cons:
          1. Home birth is not an always option if you have had any complications during pregnancy or you have a high risk pregnancy (previous medical issues, carrying multiples, previous miscarriages or stillbirths, etc.).
          2. A recent research article found that babies born at home are about 3 times more likely to die than babies born in a hospital (Wax et al., 2010).
          3. If medical complications arise for mother or baby, there will be delayed access to necessary medical equipment and personnel.  Even women who have had healthy, uncomplicated pregnancies need to have a backup plan in place for a transition from home to the hospital if complications arise during labor.
          4. You will not have the option to use pain medications at home with the exception of over-the-counter medicines that are safe to take during pregnancy.
          5. Some insurances will not cover the cost of a home birth.  Make sure you check with your insurance provider before you make the decision to give birth at home.



Disclaimer: The "Pregnancy, Babies, and Birth" blog series is meant as a source of general information only.  It's intended use is to encourage women to further consider and discuss reproductive and birthing decisions themselves, with their partners, and with their medical care providers.  Information included in this series is not intended to be professional medical advice or a substitution for a relationship with a licensed physician or practitioner.  Any serious questions or concerns about reproductive, prenatal, and/or perinatal health should be directed to your primary care physician or other licensed specialist.  Women's Services and Resources does not promote any particular brand, medical provider, birthing location, or any other specific birthing decisions.  We strongly encourage women to become as educated about their choices as possible so they are empowered to make educated decisions for themselves and their babies. ADSENSE HERE