Think twice before you choose Cesarean

By Injil Abu Bakar

BOSTON, Massachusetts (JP): It is said that some pregnant women and their husbands attempt to "fix" the date of their child's birth for a particularly auspicious date.

Probably the best means to assure an early birth is through cesarean section, or c-section as it is popularly known.

Many women also undergo c-section to avoid pain that accompany a vaginal birth, or they may believe in the false myth that delivering a baby in a normal procedure may ruin the elasticity of their vagina.

Sadly, there is not enough information about the risks of C- section, providing a greater risk for the mother.

Some of the increased risks for the mother include:

* Infection. Women develop postoperative infection of the uterus and nearby pelvic organs about 10 percent of the time.

* Excessive bleeding. There is twice as much blood loss during a c-section as there is in a vaginal birth.

* Blood clots in the legs, pelvic organs and, sometimes, the lungs.

* Death. Although death related to cesarean delivery is very rare (approximately seven per 100,000), it is four times more likely with a cesarean than with vaginal delivery.

There are also risks for the baby:

* Prematurity, if the due date is not accurately calculated. It can cause the difficulty in breathing (respiratory distress) and low birthweight.

* Depression activity due to the anesthesia being absorbed by the baby.

* Contrary to the popular belief, a cesarean birth is also more painful, more expensive, and takes longer to recover from than a vaginal birth. You can expect two days to four days in the hospital, and four to six weeks before full recovery.

At risk

The c-section is a major surgery and should only be done when the health of the mother or baby is at risk. It should not be an option for the convenience of the doctor or the parents, or for any other nonmedical reason.

Some common reasons for c-sections include:

- Cord prolapse (which takes place when the umbilical cord falls into the vagina)

- Bleeding from the placenta

- Abnormal pelvic structure, for example, as a result of a serious injury, the shoulder presentation of the baby

- Serious maternal health problems (e.g., infection, diabetes, heart disease, high blood pressure, etc.) when labor would not be safe for either mother or baby,

- Dystocia (difficult childbirth), which includes labor that fails to progress, prolonged labor, and CPD (cephalopelvic disproportion: the baby is too large to pass safely through the mother's pelvis).

- Breech presentation (buttocks or feet first).

- Fetal distress. The baby may show signs of distress such as slowing of heart rate or too much acid in the blood before vaginal delivery can be completed quickly; or a c-section may be recommended if the baby has a serious medical condition, for example, spina bifida.

Today, although about 21 percent of babies in the United States are delivered by c-section, the rate of c-section has declined, after reaching 25 percent in 1988.

But in Indonesia may actually be increasing. Hospital data from private hospitals in major cities shows the rate at from 30 percent up to 80 percent.

Common situations in which some c-sections might be avoided include:

- Repeat cesarean. Many women who have had a previous C-section may be able to deliver through vagina. In 1997, about 28 percent of women with prior C-sections had vaginal deliveries.

- Breech presentation (buttocks or feet first). Doctors often feel that a C-section is the safest when your baby is breeching. However some doctors are experienced in performing vaginal deliveries for these babies. If your baby is lying sideways (shoulder-first position), a C-section always is necessary.

- Dystocia. Sometimes, contractions slow down or the cervix is not opening enough for delivery. Treatment with a drug called oxytocin sometimes can make labor more efficient, allowing for vaginal delivery. However, if oxytocin does not speed up labor, a cesarean may be necessary.

No repeat

There was a common principle -- "once a c-section, always a C- section". It emerged years ago from the fear of the rupture along the previous incision, which usually was a high up-and-down cut in the uterus.

But today, many women can try for vaginal birth after having a previous c-section, if no risk factors are present, because uterine ruptures are uncommon with the low horizontal (side-to- side) incisions that often are used today for c-sections.

However, such ruptures do occur in about one in 200 women considered at low risk of rupture (those with one previous C- section and a low horizontal incision).

About 60 percent to 80 percent of women attempting Vaginal Birth After Cesarean (VBAC) have a successful vaginal delivery, and the reminder will need another c-section. VBAC should only attempted in a hospital or birth center where an emergency C- section can be performed if needed.

If your doctor thinks you are a good candidate for VBAC, there are a number of reasons to consider it:

- No abdominal surgery

- Lower risk of infection

- Quicker recovery

- Shorter hospital stay

- Less chance of blood transfusion

The writer is an Indonesian obstretician currently living in the United States.