Cesarean Delivery or Vaginal Birth - a Guide for Pregnant Women

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Salt Lake City, UT -- (ReleaseWire) -- 01/17/2022 -- Pregnant women may wonder where or how to deliver their baby, as well as what method of delivery – either vaginally or via Cesarean section.

The body is designed for vaginal birth, and most babies are born vaginally. But, babies can also be born surgically, through an incision in the abdomen, which is called a Cesarean delivery or C-section.

"Sometimes a C-section is needed to protect the health of the baby or mother or both, and other times, patients simply prefer a C-section delivery," said Helen Feltovich, MD, a maternal fetal medicine physician, and OB/Gyn who cares for patients with high-risk pregnancies who is with Intermountain Medical Group, based in Salt Lake City, UT.

According to Feltovich, there are several advantages of a vaginal delivery, because usually women recover faster from vaginal childbirth and their hospitals stays will be shorter.

However, there are common reasons a scheduled C-section may be recommended such as:

- Baby is in breech (feet-first or bottom-first) or transverse (sideways) position, rather than cephalic (head-down) position.

- Placenta previa—placenta is covering all or part of the opening to the birth canal.

- Maternal infection the baby can catch if delivered vaginally, such as HIV, or active genital herpes.

- Multiple gestation (being pregnant with more than one baby).

- A vertical incision on the uterus from a previous C-section or uterine surgery .

- More than two previous C-sections.

- Baby's head can't fit through the maternal pelvis.

- Baby has a large birth defect that could rupture during vaginal delivery.

Feltovich said sometimes C-sections are unplanned, but become necessary due to complications during labor or delivery and might include the following scenarios:

- Labor stops or isn't progressing, or baby can't fit through the pelvis.

- Placental abruption (placenta pulls away from uterine wall too soon, cutting off baby's oxygen).

- Umbilical cord becomes pinched or drops into the birth canal ahead of baby, which can lower baby's oxygen supply.

- Changes in baby's heart rate that suggest baby may not be getting enough oxygen

"Birth in an operating room is different from birth in a hospital room. And while a C-section is a surgery, it is primarily a birth, and this is the focus. Patients are almost always awake and typically have their partner right by them. Mom and partner can see and touch the baby, just like in a vaginal delivery," she added.

With a c-section delivery at Intermountain hospitals, as soon as the medical care team is sure the baby is stable, moms can hold their baby. Skin to skin contact as soon as possible is encouraged to promote bonding, whether the baby is born via vaginal or Cesarean delivery.

"A C-section delivery is major abdominal surgery and like any surgery, it comes with some risks. If it's elective, your doctor or midwife can help you evaluate if the benefits of having a C-section outweigh the risks. If there are medical indications, your provider will explain these to you," said Feltovich.

Once you have a C-section, you have a choice about whether or not to have a C-section in the future, or try for a VBAC (vaginal birth after Cesarean). After you have had two C-sections, it's generally not recommended to try a vaginal delivery.

"With any surgery, there are risks for possible complications such as infection, injury to bladder or bowel, blood clots and in rare cases, brain damage or death. However, many of these risks apply to pregnancy or delivery in general and they are very, very low. Risks for the baby include a possible increased chance of breathing problems, and extreme sleepiness can occur in the unusual case that general anesthesia is needed," said Feltovich.

The C-section rate in the U.S. is a public health issue because of the small increased risk of complication, and increased time of hospitalization. Average stay is two days for a vaginal delivery and 3-4 days for a C-section.

"Intermountain Healthcare has been an early adopter of national recommendations to reduce the rate of C-section in American women, and has one of the lowest C-section rates in the country. That said, sometimes patients need to have a C-section for their safety or that of their baby. Intermountain is committed to adhering to evidence-based recommendations for C-section delivery, while simultaneously honoring patients' wishes for how their babies will be delivered," added Feltovich.

A vaginal birth after Cesarean (VBAC) delivery is possible for anyone who has had only one or two C-section deliveries. There is a small but serious risk of the uterus rupturing during a VBAC delivery because the uterus has a scar from the previous surgery. Talk with your provider about your specific medical history to see if you're a candidate for a VBAC delivery. Factors involved in the decision include the reason for your previous C-section; the type of uterine incision (if it was low on the belly and done side-to-side, it's more likely you can try VBAC); when your last delivery occurred (less or more than 18 months ago), and other factors.

Dr. Feltovich offers the following do's and don'ts for recovery after a C-section.

Do:
- Take time to sit and bond with your baby.
- Rest when you're tired.
- Walk every day to maintain strength, and prevent blood clots and constipation.
- Hold a pillow over your incision when you need to cough or laugh to be more comfortable.
- Shower normally (or take a bath after two weeks).
- Eat healthily
- Drink plenty of water and fluids.
- Take a fiber supplement daily to avoid constipation.

Don't:
- Lift anything heavier than your baby.
- Use tampons or douche for at least six weeks.
- Take baths for about two weeks, until your incision is healed.
- Participate in rigorous activity or core muscle exercises until recommended by your doctor.
- Have sex until your body feels ready (at least two weeks).
- Be afraid to ask for help from friends or family.
- Soak in public pools or hot tubs for at least six weeks.
- Crash diet

C-Section incision care:

- Keep the incision area dry and clean.
- Use warm, soapy water to gently wash your incision daily (usually when you shower).
- Pat the area dry, after cleaning.
- If your doctor used tape strips on your incision, let them fall off on their own. This usually takes about a week.

When to call your doctor:

- Depression, sadness, hopelessness, or having troubling thoughts.
- Signs of an infection including pain, pus, swelling, redness, swollen lymph nodes
- Fever of more than 100.4 degrees Fahrenheit.
- Difficulty breathing.
- Vaginal discharge that smells bad.
- Severe pain in your belly.
- Bright red vaginal bleeding that soaks through more than one pad in two hours or less.
- Vaginal bleeding that gets worse or is still bright red more than four days after birth.
- Signs of a blood clot, including pain in your thigh, groin, back of knee, or calf.
- Incision comes open.
- Nausea or vomiting.
- Vaginal blood clots larger than a golf ball.
- Trouble passing urine or stool.

For more information about visit intermountainhealthcare.org.

About Intermountain Healthcare
Located in Utah, Idaho, and Nevada, Intermountain Healthcare is a nonprofit system of 25 hospitals, 225 clinics, the Intermountain Medical Group with some 2,700 employed physicians and advanced care practitioners, a health plans division called SelectHealth, Homecare, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs. For updates, see https://intermountainhealthcare.org/news.

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