Can you prevent a Caesarean

Can you prevent having a Caesarean birth? Probably not. If your baby is in a breech position, you can ask your health care provider whether it would be possible for him or her to turn the baby into the proper position for a vaginal birth, a procedure called an external version. But the decision to perform a Caesarean will depend on your doctor's assessment of your health and the health of your baby. If either of you is in danger, a Caesarean birth may be necessary. Remember, your aim is to be a healthy mom for a healthy baby, no matter what it takes. Be sure you have a trusting relationship with your health care provider and her or his team. When something goes wrong in labor, it's best to have confidence in those who are advising you.

Risks of Caesarean birth

A Caesarean birth is major surgery. Although it's considered a very safe procedure, it carries certain risks, including the risk of death. Although a woman's risk of death after a Caesarean birth is very low — estimated at about two in 10,000 — it's about twice as great as the risk is if she was to deliver vaginally. One important point to remember: Caesarean deliveries are often performed to resolve life-threatening complications. It's to be expected that more complications would arise in those women.

Risks for you

Other risks are higher with Caesarean birth than with vaginal delivery. These include:

• Increased bleeding. On average, blood loss during Caesarean birth is about twice that as during vaginal birth. However, blood transfusions are rarely needed during Caesarean birth, typically only about 3 percent of the time.

• Reactions to anesthesia. The medications used during surgery, including those used for anesthesia, can sometimes cause unexpected responses, including breathing problems. In rare cases, general anesthesia can lead to pneumonia when a woman aspirates stomach contents into the lungs. However, general anesthesia is used in less than 20 percent of Caesarean births, and precautions are specifically taken to avoid these complications.

• Inadvertent injury to your bladder or bowel. These surgical injuries are rare, but they're recognized complications of Caesarean birth.

• Endometritis. This condition causes an inflammation and infection of the membrane lining your uterus. It's the most frequent complication associated with Caesarean birth. It occurs when bacteria that normally inhabit your vagina make their way into your uterus. Endometritis is up to 20 times more likely to occur after a Caesarean birth than after a vaginal childbirth.

Urinary tract infection. Urinary tract infections, such as bladder infections and kidney infections, rank second to endometritis as a cause of complications after a Caesarean birth.

• Decreased bowel function. Most women have few if any gastrointestinal problems after a Caesarean birth. In some cases, though, the drugs used for anesthesia and pain relief may lead the bowel to slow down for a few days after surgery, resulting in temporary distention of the abdomen, bloating and discomfort.

• Blood clots in your legs, lungs or pelvic organs. The risk of developing a blood clot inside a vein is about three to five times greater after a Caesarean childbirth than after a vaginal delivery. If untreated, a blood clot in the leg can travel to your heart and lungs. There it can obstruct blood flow, causing chest pain, shortness of breath and even death. Clotting can also occur in the pelvic veins. This, too, is more common after Caesarean birth.

• Wound infection. Wound infection rates following Caesarean birth vary. An elective, repeat Caesarean birth generally has a wound infection rate of about 2 percent. Caesareans that follow labor, particularly if your membranes have ruptured (your water has broken), have a wound infection rate of 5 percent to 10 percent. Your chances of developing wound infection after a Caesarean birth are higher if you abuse alcohol, have type 2 diabetes (formerly called adult-onset or noninsulin-dependent diabetes) or are obese, which is defined as having a body mass index of 30 or higher.

• Wound rupture. When a wound is infected or healing poorly, it's more likely to split open along the surgical suture lines. This occurs in only about 5 percent of wound infections.

• Placenta accreta and hysterectomy. Placenta accreta is the term used to describe a placenta attached too deeply and too firmly to the wall of the uterus. If you've had a previous Caesarean birth, your risk of developing placenta accreta in a subsequent pregnancy is increased. Placenta accreta is closely associated with placenta previa — abnormal position of the placenta inside the uterus. About 25 percent of women having a Caesarean birth for placenta previa, and who've also had a previous Caesarean, need a post-Caesarean hysterectomy for placenta accreta. In fact, placenta accreta is currently the most common reason for post-Caesarean hysterectomy.

• Rehospitalization. A recent study found that compared with women who deliver vaginally, women who deliver by Caesarean birth are twice as likely to be hospitalized again in the two months after giving birth.

Risks for your baby

Caesarean birth also poses potential risks for your baby. These include:

• Premature birth. In a Caesarean birth by choice, it's important that dates are very accurately assessed or a sample of the amniotic fluid is tested for lung maturity. Delivering a baby prematurely may lead to difficulty breathing and low birth weight.

• Breathing problems. Babies born by Caesarean are more likely to develop a minor breathing problem called transient tachypnea, a condition marked by abnormally fast breathing during the first few days after birth.

• Fetal injury. Although rare, accidental nicks to the baby can occur during surgery.

Managing anxiety about Caesarean birth

Getting the unexpected news that you need a Caesarean can be stressful, both for you and your partner. In an instant, your expectations about giving birth and caring for your new baby abruptly change. To make things worse, this news often comes when you're tired and discouraged from ineffective labor. In addition, there's often not much time for your health care provider to explain the procedure and answer your questions. This is especially true in the case of an emergency Caesarean birth.

It's normal to have some worries about how you and your baby will fare during a Caesarean birth. But don't let these worries get the better of you. Almost all mothers and babies recover well after Caesarean birth, with few problems. If you're feeling disappointed that you need a Caesarean, try to let it go. Although you would probably have preferred a vaginal birth, remind yourself that your health and the health of your baby are much more important than the method of delivery.

If you're scheduled for a repeat Caesarean birth, you may also be anxious. You may have disturbing memories of your last Caesarean. You may be concerned about how you'll care for your new baby and your other child or children while recovering from major surgery. On the other hand, you may feel relieved that you won't have to go through labor. Being able to schedule your baby's arrival may give you a sense of calm. Each woman is different.

If you're feeling anxious about a scheduled repeat Caesarean birth, discuss your fears with your health care provider, childbirth educator or partner. Sharing your feelings will probably make you feel less worried. Tell yourself that you made it through once before — and you can do it again. If anything, recovering from a Caesarean will probably be easier this time around. You know more than you once did, and your coping skills are probably better now, too.

What you can expect during a Caesarean birth

Preoperative preparation

Whether your Caesarean childbirth is planned or unexpected, you'll undergo a series of steps to prepare for the surgery. The standard steps are listed below. In an emergency, some of these steps might be cut short or left out entirely.

Discussing your anesthesia options

An anesthesiologist can come to your hospital room to assess your condition and circumstances and to recommend which type of anesthesia (spinal, epidural or general) is best. The recommendation depends on many factors. Which type of anesthesia is safest for your baby? Which is safest for you? Which options are feasible right now?

Spinal, epidural and general anesthesia are all used for Caesarean births. Spinal and epidural anesthesia numb your body from the chest down, allowing you to remain awake for the procedure. You feel little or no pain, and little or no medication reaches your baby.

The differences between spinal and epidural anesthesia are fairly small. With a spinal block, pain-relieving medication is injected into the fluid surrounding your spinal nerves. With an epidural, this medication is injected just outside the fluid-filled space surrounding your spinal cord. An epidural takes about 20 minutes to administer and lasts almost indefinitely. A spinal block can be performed more quickly but usually only lasts about two hours. In an emergency situation, there's often not enough time for an epidural. Spinal block and epidural are each used in about 40 percent of Caesarean births.

General anesthesia, during which you're completely unconscious, is typically used in emergency Caesarean births, when your baby needs to be delivered as quickly as possible. Some of the medication does reach your baby, but this doesn't cause any problems that an attendant pediatrician can't readily deal with. Most babies show no effect of general anesthesia, since the mother's brain absorbs the medication promptly and to a large extent. If necessary, your baby can be given medications to counteract any effects of the anesthesia.

Undergoing other preparations

Once you, your doctor and the anesthesiologist have decided which type of anesthesia you'll have, preparations begin in earnest. These typically include:

• Getting an IV. Your nurse can insert an intravenous (IV) needle into your hand or arm. This will allow you to receive fluids and medications during and after surgery.

• Providing blood samples. Your nurse will likely collect these samples and send them to the hospital lab for analysis. These lab tests will allow your doctor to have a more complete picture of your baseline condition — that is, your presurgery condition.

• Taking an antacid. You may be given an antacid to neutralize your stomach acids. This simple step greatly diminishes the possibility of damage to your lungs if stomach contents were to enter during anesthesia.

• Placement of monitors. Your anesthesiologist or nurse will probably wrap a blood pressure cuff around your arm so that your blood pressure can be monitored during surgery. You can also be hooked up to a cardiac monitor through electrodes stuck to your chest to monitor your heart rate and rhythm during surgery. A saturation monitor can be clamped onto your finger to monitor the oxygen level in your blood.

• Receiving a urinary catheter. A thin tube called a catheter can be inserted into your bladder to drain urine so that your bladder will stay empty during surgery.

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