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Q&A: Top reasons for a “C-Section”

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Childbirth is physiology of the human body at its best. While the weeks are counted down, pregnancy books are perused and nursery items are assembled, when it comes time for the birth, labor and delivery do not always go as planned.

Dr. Shan Shan Jiang, an OBGYN specialist at Consultants in OB/GYN, sheds light on important elements of labor that are vital for keeping both mother and baby healthy and safe.

 Why should expecting mothers strive toward a vaginal birth when possible?

There are a number of potentially positive consequences from a vaginal birth, including:

  • Less risk of internal organ damage to the mother.
  • Breastfeeding may be more effective.
  • Mother is much less likely to require a C-section delivery in subsequent pregnancies.

What are the top medical indications for a C-section?

  • If you have had a prior C-section.
  • If you have had prior surgery on the uterus.
  • The baby is breech.
  • Signs of fetal distress.
  • Failure or lack of progression of labor.

What is “failure to progress?”

women-group-pregnantIn active labor, you can have an arrest of dilation. Once you start pushing, you can have arrest of descent.

When the cervix is 6 cm dilated, it is considered active labor. If you have strong and adequate contractions for four hours without a dilation change of your cervix, it is considered “arrest of dilation.”

When the cervix is 10 cm dilated, your provider will ask you to start pushing. If the baby hasn’t been delivered after four hours of pushing, it’s time to think about assisting the birth with birthing forceps or vacuum, versus C-section. This is considered “arrest of descent.”

A C-section is recommended in these situations to minimize health risks for mom and baby.

 If my cervix does not dilate on its own, what are some ways to help my labor progress toward a vaginal delivery?

Your provider may recommend breaking your water by starting oxytocin to help strengthen your contractions.

When my doctor or midwife asks for “internal monitors,” what does it mean?

There are two types of internal monitors. One is called an intrauterine pressure catheter (IUPC), which is a catheter placed between baby’s head and the uterine wall that measures the strength of contractions. This is used to prevent a C-section by making sure your contractions are strong enough to dilate your cervix.

The other is called a fetal scalp electrode. It is like placing an acupuncture needle on baby’s scalp during labor to better monitor baby’s heart rate. It is typically used when the baby needs to be repositioned to improve oxygenation to the baby.

Does getting an epidural increase my chance of needing a C-section?

Epidurals increase the average amount of time from start of labor to delivery but don’t significantly increase the risk for having a C-section.[1]

 If I had a C-section before, does it mean I will always need a C-section for my subsequent pregnancies?

No, a trial of labor after C-section (TOLAC) can be a very safe option for expecting moms who have had a previous C-section. In fact, you can consider a TOLAC even with two previous C-sections. Talk to your doctor or midwife for more details on the risks and benefits.

Combining her passion for the social sciences and expertise in obstetrics and gynecology, Dr. Jiang strives to provide highly personalized, comprehensive care to women of all ages. Dr. Jiang and the Consultants in OB/GYN team specialize in obstetric and gynecologic care. Call 303-322-2240 or visit www.consobgyn.com to make an appointment.

 [1] The College of Family Physicians of Canada. Does epidural analgesia increase rate of cesarean section? 10 April 2006. In partnership with Mile High Mamas
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