Think twice before you choose Cesarean<\/p>\n
By Injil Abu Bakar<\/p>\n
BOSTON, Massachusetts (JP): It is said that some pregnant
\nwomen and their husbands attempt to \"fix\" the date of their
\nchild's birth for a particularly auspicious date.<\/p>\n
Probably the best means to assure an early birth is through
\ncesarean section, or c-section as it is popularly known.<\/p>\n
Many women also undergo c-section to avoid pain that accompany
\na vaginal birth, or they may believe in the false myth that
\ndelivering a baby in a normal procedure may ruin the elasticity
\nof their vagina.<\/p>\n
Sadly, there is not enough information about the risks of C-
\nsection, providing a greater risk for the mother.<\/p>\n
Some of the increased risks for the mother include:<\/p>\n
* Infection. Women develop postoperative infection of the uterus
\nand nearby pelvic organs about 10 percent of the time.<\/p>\n
* Excessive bleeding. There is twice as much blood loss during a
\nc-section as there is in a vaginal birth.<\/p>\n
* Blood clots in the legs, pelvic organs and, sometimes, the
\nlungs.<\/p>\n
* Death. Although death related to cesarean delivery is very rare
\n(approximately seven per 100,000), it is four times more likely
\nwith a cesarean than with vaginal delivery.<\/p>\n
There are also risks for the baby:<\/p>\n
* Prematurity, if the due date is not accurately calculated. It
\ncan cause the difficulty in breathing (respiratory distress) and
\nlow birthweight.<\/p>\n
* Depression activity due to the anesthesia being absorbed by the
\nbaby.<\/p>\n
* Contrary to the popular belief, a cesarean birth is also more
\npainful, more expensive, and takes longer to recover from than a
\nvaginal birth. You can expect two days to four days in the
\nhospital, and four to six weeks before full recovery.<\/p>\n
At risk<\/p>\n
The c-section is a major surgery and should only be done when
\nthe health of the mother or baby is at risk. It should not be an
\noption for the convenience of the doctor or the parents, or for
\nany other nonmedical reason.<\/p>\n
Some common reasons for c-sections include:<\/p>\n
- Cord prolapse (which takes place when the umbilical cord falls
\ninto the vagina)<\/p>\n
- Bleeding from the placenta<\/p>\n
- Abnormal pelvic structure, for example, as a result of a
\nserious injury, the shoulder presentation of the baby<\/p>\n
- Serious maternal health problems (e.g., infection, diabetes,
\nheart disease, high blood pressure, etc.) when labor would not be
\nsafe for either mother or baby,<\/p>\n
- Dystocia (difficult childbirth), which includes labor that
\nfails to progress, prolonged labor, and CPD (cephalopelvic
\ndisproportion: the baby is too large to pass safely through the
\nmother's pelvis).<\/p>\n
- Breech presentation (buttocks or feet first).<\/p>\n
- Fetal distress. The baby may show signs of distress such as
\nslowing of heart rate or too much acid in the blood before
\nvaginal delivery can be completed quickly; or a c-section may be
\nrecommended if the baby has a serious medical condition, for
\nexample, spina bifida.<\/p>\n
Today, although about 21 percent of babies in the United
\nStates are delivered by c-section, the rate of c-section has
\ndeclined, after reaching 25 percent in 1988.<\/p>\n
But in Indonesia may actually be increasing. Hospital data
\nfrom private hospitals in major cities shows the rate at from 30
\npercent up to 80 percent.<\/p>\n
Common situations in which some c-sections might be avoided
\ninclude:<\/p>\n
- Repeat cesarean. Many women who have had a previous C-section
\nmay be able to deliver through vagina. In 1997, about 28 percent
\nof women with prior C-sections had vaginal deliveries.<\/p>\n
- Breech presentation (buttocks or feet first). Doctors often
\nfeel that a C-section is the safest when your baby is breeching.
\nHowever some doctors are experienced in performing vaginal
\ndeliveries for these babies. If your baby is lying sideways
\n(shoulder-first position), a C-section always is necessary.<\/p>\n
- Dystocia. Sometimes, contractions slow down or the cervix is
\nnot opening enough for delivery. Treatment with a drug called
\noxytocin sometimes can make labor more efficient, allowing for
\nvaginal delivery. However, if oxytocin does not speed up labor, a
\ncesarean may be necessary.<\/p>\n
No repeat<\/p>\n
There was a common principle -- \"once a c-section, always a C-
\nsection\". It emerged years ago from the fear of the rupture along
\nthe previous incision, which usually was a high up-and-down cut
\nin the uterus.<\/p>\n
But today, many women can try for vaginal birth after having a
\nprevious c-section, if no risk factors are present, because
\nuterine ruptures are uncommon with the low horizontal (side-to-
\nside) incisions that often are used today for c-sections.<\/p>\n
However, such ruptures do occur in about one in 200 women
\nconsidered at low risk of rupture (those with one previous C-
\nsection and a low horizontal incision).<\/p>\n
About 60 percent to 80 percent of women attempting Vaginal
\nBirth After Cesarean (VBAC) have a successful vaginal delivery,
\nand the reminder will need another c-section. VBAC should only
\nattempted in a hospital or birth center where an emergency C-
\nsection can be performed if needed.<\/p>\n
If your doctor thinks you are a good candidate for VBAC, there
\nare a number of reasons to consider it:<\/p>\n
- No abdominal surgery<\/p>\n
- Lower risk of infection<\/p>\n
- Quicker recovery<\/p>\n
- Shorter hospital stay<\/p>\n
- Less chance of blood transfusion<\/p>\n
The writer is an Indonesian obstretician currently living in
\nthe United States.<\/p>",
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