by Kathleen Gardner, MD
When it comes to having a baby, everyone’s goal is a healthy child who enters the world in a manner that is safe for both the mother and the baby. The majority of deliveries happen naturally and without complications. There are, however, special circumstances in which the delivery of a baby by cesarean section is the best option. This article is a brief discussion of some of the more common instances in which a caesarian section may be the safer choice.
What is a cesarean section?
A cesarean section (C-section) is the operative delivery of an infant through an incision in the wall of the uterus. It is performed, as an alternative to vaginal delivery, when there are maternal or fetal indications that vaginal childbirth is not feasible or safe.
What is the difference between planned and emergency C-sections?
There are certain instances in which a woman and her obstetrician may plan ahead for delivery by C-section. One of the most common circumstances is the birth of a child following previous childbirth by C-section. Many of these mothers decide not to undergo a trial of labor in the hopes of having a vaginal birth, due to their previous labor and birth experience. Others have existing medical concerns that make a trial of labor after a previous C-section unadvisable.
Another common indicator for planned C-section is multiple births, when a mother is expecting twins or triplets. We have a number of multiple births each year in this community, due in part to the incidence of infertility in older moms.
Additionally, when a woman develops pregnancy-related complications–such as uncontrolled diabetes or preeclampsia–a planned C-section may be her safest birth option. We recommend that C-sections not be performed before the pregnancy is 39 weeks along to help ensure proper lung development; however, a woman with preeclampsia may need to deliver even earlier. Preeclampsia is a serious vascular condition that should be followed closely in weekly visits with your obstetrician.
The most common reasons for emergency C-sections are signs of fetal distress, which is monitored by tracking the baby’s heart rate. There are several conditions that can lead to fetal distress. For example, if the umbilical cord drops through the cervix first (umbilical cord prolapse), depriving the baby of oxygen, a C-section can save the baby’s life. Also, when a mother is in active labor and it is determined that the baby is in an abnormal position, a C-section is necessary for a safe delivery. An example of this could be a breech presentation. Sometimes the decision for C-section comes down to problems with the labor process: The mother’s cervix is not dilating sufficiently, the passage is too small and the baby is too big.
What is a vaginal birth after cesarean (VBAC)?
Many mothers who had a primary c-section (for the delivery of their first baby) are eager to try a vaginal delivery with a later pregnancy and more than half of these mothers do have a successful vaginal delivery. Because there can be a higher level of risk involved in VBAC, it is not typically offered outside of large hospitals; however, VBAC is available at Cayuga Medical Center. The obstetricians, anesthesiologists, and administration are committed to offering this option for mothers who want it, which is atypical for a community hospital.
The maternal and newborn care specialists practicing at Cayuga Medical Center are dedicated to providing a safe experience and pleasant environment for all mothers and infants. Breastfeeding begins immediately following birth for C-section deliveries. Once the neonatologist has checked over the baby, he or she goes right to the breast while the obstetrician completes the surgery. The mother may choose to have her husband or life partner in the operating room, which is located within Cayuga Birth Place, the medical center’s brand new maternity unit. Our goal is to make this surgical procedure a gentle process for both mom and baby.
Dr. Gardner is a board certified in obstetrics and gynecology and is on the medical staff of Cayuga Medical Center. She is in practice with Ob-Gyn Associates of Ithaca, where she can be reached at (607) 266-7800.