Trusted Information for Healthy Pregnancies
vaginal birth
Vaginal birth can be OK after multiple C-sections
Feb 18th
Women who attempt vaginal childbirth after having several babies by cesarean section may not have a greater risk of complications than women who've had only one prior C-section, a new study suggests.
Still, the American College of Obstetrics and Gynecology (ACOG) does not currently recommend vaginal delivery for women who have had three or more C-sections, as their risk of uterine rupture has generally been thought to be higher.
In the new study, however, researchers found that women with at least three prior C-sections showed no increased risk of uterine rupture during vaginal delivery.
In fact, none of the 89 women who opted to try vaginal childbirth had the complication, according to findings published in the British obstetrics journal BJOG.
Based on past research, the expected rate of uterine rupture among women with one prior C-section would be less than 1 percent; a large 2004 study of U.S. women, for example, found a rate of 0.7 percent.
These latest findings suggest it would be "reasonable to reconsider" the current ACOG recommendations for women with three or more prior C-sections, according to lead researcher Dr. Alison G. Cahill of Washington University School of Medicine in St. Louis.
For their study, Cahill and her colleagues reviewed the records of 25,000 women at 17 U.S. hospitals who gave birth after having at least one prior C-section. The group included 860 women with at least three prior C-sections, 89 of whom attempted a vaginal delivery; the remaining 771 elected to have a repeat C-section.
There were no cases of uterine rupture in either group, the researchers found.
The 89 women who chose to try labor also had no instances of bladder or bowel injury, or lacerations of the uterine artery -- the other main complications the researchers assessed. That compared with just over 2 percent of the women who had a repeat C-section -- though that difference, the researchers say, is not significant in statistical terms.
When it came to successful delivery -- meaning the doctor did not have to switch to a C-section during labor -- the chances were similar regardless of the number of prior C-sections.
Just over 13,600 women with one or two prior C-sections elected to try vaginal delivery, with a success rate of about 75 percent. That rate was 80 percent among women with a history of three or more C-sections.
Cahill pointed out that all of the women in the study had had C-sections done with what is called a low transverse incision -- a horizontal cut across the lowest part of the uterus. These types of incisions have a lower risk of rupture compared with the "classical" high vertical incision, an up-and-down incision made higher on the uterus.
Another factor to consider in the decision to try vaginal delivery after cesarean, according to Cahill, is whether a woman has ever had a previous vaginal birth. Previous vaginal deliveries increase the chances of success with a post-cesarean attempt at vaginal birth.
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Why a Page woman traveled 350 miles to Valley to have baby
Feb 16th
In order to deliver her baby the way she wanted, a woman said she would have to come to the Valley, 350 miles away from her home in Page.
Joy Szabo has four boys. Her first delivery was vaginal, her second a cesarean, her third a vaginal birth after cesarean or VBAC.
For her fourth... "I knew from the beginning that I wanted to deliver him vaginally, I had already had a successful VBAC and my doctor was on board with that," said Joy.
She planned to deliver at Banner's Page Hospital, until she learned the hospital would no longer allow VBAC births.
Joy spoke with the CEO.
“She told me she didn’t see any reason why I shouldn’t be able to deliver vaginally, but it wasn’t going to happen there. I needed to find some place else,” said Joy.
At this time Joy was entering her last trimester. She checked into it and home birth wasn’t an option. It’s illegal for a midwife to allow a woman to VBAC at home.
She would have to come to the Valley for a VBAC birth, 350 miles away from her Page home. With a husband and three young boys it wasn’t an easy task.
She was doing all this to avoid the risks that come along with a c-section surgery, but VBACs carry their own dangers. The biggest is the possible rupture of the C-section scar on the uterus.
OBGYN Dr. Roger Seymann has seen it and no longer handles VBACs because of it.
“Observing the horrendous outcome of opening the abdomen, seeing a baby in the belly, knowing this baby has a risk of neurologic damage, if it has in fact survived at all,” said Dr. Seymann.
Banner Hospitals say they don’t allow VBACs at their rural locations because they can’t provide the 24/7 care needed in case of a rupture.
Joy ended up delivering at Banner Gateway with a doula and a doctor that would work with her wishes.
Her doctor was Dr. Christine Brass of Mesa.
“I just carefully choose with the patient themselves you know who is going to be the best candidate for proceeding with a vaginal birth after cesarean,” said Dr. Brass.
She says there are plenty of factors that go into that consideration. Dr. Brass says women who had a c-section the first time because the baby was too big for their birth canal probably aren’t good candidates. A woman who has done a VBAC before, like Joy, is a great candidate.
Joy says she couldn’t be more happy with the outcome.
“There is an emotional side to delivering your own baby and being able to see what’s happening and participating in the process that really is valuable,” said Joy.
The ACOG guidelines recommend that both obstetrician and anesthesiologist need to be immediately available for elective VBAC in order to meet patient safety standards for laboring mothers and their infants.
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Natural Delivery OK in Cases of Intrauterine Growth Restriction
Feb 5th
Waiting for natural birth is as effective as inducing labor in pregnant women with intrauterine growth restriction (IUGR), a new study shows.
IUGR, which affects about 10 percent of pregnant women, means that the fetus is much smaller than normal. At birth, these babies are more likely to have low blood sugar, an abnormally high red blood cell count and trouble maintaining their body temperature. These babies are also at increased risk for jaundice, infections and cerebral palsy.
Later in life, people who were restricted-growth babies may be more prone to behavioral disorders, obesity, heart disease, type 2 diabetes and high blood pressure.
Currently, doctors have two main approaches for women with suspected IUGR who are nearing delivery. Some doctors induce labor because they're concerned about complications, while others await natural delivery.
This study compared the effectiveness of the two strategies among 650 women in The Netherlands. The researchers found that median birth weight was significantly lower among babies born after induced labor (2,420 grams) than among those in the spontaneous delivery group (2,560 grams). Both groups of babies had similar rates of adverse post-delivery outcomes.
The findings show that waiting for birth is equally as effective as inducing labor, the researchers concluded.
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Delivery mode not altered by pregnancy exercise
Jan 28th
Women benefit from light-intensity resistance exercise during pregnancy and this type of physical activity is not apt to alter the way they deliver their baby, study findings hint.
Regular exercise during pregnancy offers overall health benefits, Dr. Ruben Barakat, at Universidad Politecnica de Madrid in Spain, and colleagues note in the American Journal of Obstetrics and Gynecology. However, few investigations have focused on the effects of resistance-type exercise during pregnancy and whether this alters actual childbirth.
Therefore, they compared delivery outcomes after supervised toning and resistance exercises for shoulders, arms, pelvis, and legs, plus toning and mobilization of associated joints, in 80 women during mid to late pregnancy, compared with 80 non-exercising peers.
All of the women previously obtained less than 20 minutes of exercise on 3 or fewer days each week, a low level of exercise the "controls" maintained. By contrast, the exercise group participated in 3 weekly toning and resistance sessions of less than an hour each from pregnancy week 12 or 13 through delivery.
There were no adverse effects noted in the 72 exercising women or the 70 controls that completed the study.
And, in contrast to a previous report of increased vaginal delivery associated with regular exercise during pregnancy, Barakat's team found no differences in delivery mode between the groups.
Fifty-one exercisers delivered vaginally, another 10 had a delivery requiring instruments, and 11 had Cesarean, compared with 50, 9, and 11, respectively, in the non-exercisers.
The groups also similarly required epidural anesthesia and had similar average durations of complete dilation and delivery, and their newborns were similarly healthy.
"Women in the training group were rather pleased with the exercise training," Barakat and colleagues note in their report.
This finding, coupled with the exercisers desire to be physically active during future pregnancies, and the lack of exercise complications, supports the overall benefits of supervised, light-intensity exercise during pregnancy, they conclude.
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Readmissions After Cesarean Higher Than Vaginal Delivery
Jan 8th
Hospital readmissions for women in the postpartum period are often due to infections, and women have a higher risk of readmission after cesarean than vaginal deliveries, according to research published in the January issue of the American Journal of Obstetrics & Gynecology.
Michael A. Belfort, M.D., of the Hospital Corporation of America (HCA) in Nashville, Tenn., and colleagues analyzed 222,751 deliveries in 2007 in 114 HCA hospitals to evaluate reasons for readmission after delivery.
Of this group, the researchers found that 2,655 women (1.2 percent) were readmitted within six weeks. Readmission was more common after cesarean than vaginal delivery (1.8 versus 0.83 percent). Hypertension and uterine and wound infections were the most common reasons for readmission, though readmissions for cholecystitis, appendicitis, and pneumonia were also notable.
"Our data confirm that, although readmissions in the first six weeks after delivery are uncommon, cesarean delivery carries with it roughly twice the risk for readmission as does vaginal birth," the authors write. "Perhaps of most interest was our observation of a significantly higher rate of hospital readmission for cholecystitis, appendicitis, and pneumonia in the first few postpartum weeks than would be expected by chance. None of these conditions has ever before been linked causally to pregnancy or delivery."
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