After a Cesarean

Thank you to ICAN for making this amazing brochure to help women all across the world. For those who are unable or have not seen the brochure at this point, I took the time to type out most of the information on it.

Make an informed choice about the risks of repeat cesareans Vs. VBAC.

Cesarean sections are major abdominal surgery, and like all surgery, carry the risks of complications. These can include dense adhesion's, excessive scar tissue growth that connects the uterus to surrounding tissues and organs. Adhesion's can increase the risk of longer operation times and injury to adjacent organs. The risk of hysterectomy, or the surgical removal of the uterus, also rises. Undergoing repeated cesareans make it more likely a woman will experience placenta accreta, in which the placenta grows into the middle layer of the uterus, possibly causing hemorrhage and requiring a hysterectomy.

A woman who has repeat cesareans can also be more likely to experience thromboebolisms (blood clots that break lose and block vessels), or experience blood loss. And while uterine rupture (a rare but potentially catastrophic event during pregnancy or childbirth in which the uterine wall splits open) remains a concern after one or more cesareans, the risk of uterine rupture is small, and it decreases further with each additional VBAC.

Lets Look at the numbers....

1st Cesarean
Risk of Hysterectomy : 0.65% (1 in 154)
Risk of Blood Transfusion : 4.05% (1 in 25)
Risk of Placenta Accreta : 0.24% (1 in 417)

1st VBAC
Chance of Successful VBAC : 63.3% (2 in 3)
Risk of Uterine Rupture : 0.87% (1 in 115)
Risk of Hysterectomy : 0.23% (1 in 435)
Risk of Blood Transfusion : 1.89% (1 in 53)

2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion's : 21.6% (1 in 5)

2nd VBAC
Chance of Successful VBAC : 87.6% (9 in 10)
Risk of Uterine Rupture : 0.45% (1 in 222)
Risk of Hysterectomy : 0.17% (1 in 588)
Risk of Blood Transfusion : 1.24% (1 in 81)

3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion's : 32.2% (1 in 3)

3rd VBAC
Chance of Successful VBAC : 90.9% (9 in 10)
Risk of Uterine Rupture : 0.38% (1 in 263)
Risk of Hysterectomy : 0.06% (1 in 1667)
Risk of Blood Transfusion : 0.99% (1 in 101)

4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in 8)
Risk of Dense Adhesion's : 42.2% (2 in 5)

Note : "Major complications" include one of more of the following : uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.

Sources : Mercer, B. M., & Gilbert, S. et al. Labor Outcomes with increasing number or prior vaginal births after a cesarean delivery. Obstetrics & Gynocology 2008; 111: 285-291.

Silver, R.M, & Landom M. B., et al. Maternal morbidity associated with multiple repeat cesarean deliveres. Obstetrics & Gynocology. 2006; 107: 1226-1232.

Nisenblat, V., Barak, S., & Griness, O.B., et al. Maternal complications associated with multiple cesarean deliveres. Obstetrics & Gynecology 2006; 108: 21-6

All VBAC statistics for this are taken from the Mercer & Gilbert study in which includes induced and augmented labors. Additional studies have shown lower uterine rupture rates (especially with spontaneous labors) and higher VBAC success rates.

Elective Repeat Cesareans May Put Your Baby At Risk

According to a new study out by The University of Colorado Hospital, having a repeat cesarean section electively, may but your baby at an increased risk than having a VBAC (Vaginal Birth after Cesarean) would. For the full text of this article, visit this link.

The babies of women who have an elective repeat Cesarean delivery are twice as likely to be admitted to the neonatal intensive care unit than babies of women who have a vaginal birth after Cesarean (VBAC). That’s according to a new study from the University of Colorado Denver School of Medicine.

The study shows babies born to women who have elective repeat Cesarean deliveries also continue to need oxygen in the neonatal intensive care unit.

Which in turn is creating a huge cost for not only the mother who had the elective surgery which often is twice the price of an actual VBAC, but then you are adding the NICU costs to the mix which can be absorbent.

Kamath and researchers from UC Denver, Colorado School of Public Health and The Children’s Hospital looked at the records of 672 women who gave birth at University of Colorado Hospital. Each of the women had one prior Cesarean delivery. Three-hundred-forty- three decided to have another Cesarean while 329 planned a vaginal birth.

Chocolate or Vanilla?

I saw the debate between cesarean section, or vaginal birth put into a pretty cut and dry term today. Chocolate or Vanilla?
And it made me think...
In society today, many people do view birth this way. Many do not sit down and really look at the risks that come with the choice they make for an elective cesarean section.
Now when we use the term elective, we mean, non medically necessary. No medical reason for this choice. This includes elective repeat cesareans for NO medical reason, and having a previous cesarean section does not constitute as a medical reason for a cesarean section.

A couple medical reasons for having a cesarean section are....

• There are problems with the placenta. This is the organ that nourishes your baby in the womb. Placenta problems can cause dangerous bleeding during vaginal birth.
• Pregnancy with multiple babies.
• Placenta Accreta
  
• The baby's umbilical cord slips into the vagina, where it could be squeezed or flattened during vaginal delivery. This is called umbilical cord prolapse.
• Fetal Distress
• Birth defects.

Now, granted, there are medically necessary cesarean sections that take place, but many women do not know or understand the serious risk of an elective cesarean without a medical reason.

Some of the risks of a cesarean section include....

• Infection. The uterus or nearby pelvic organs such as the bladder or kidneys can become infected.
• Increased blood loss. Blood loss on the average is about twice as much with cesarean birth as with vaginal birth. However, blood transfusions are rarely needed during a cesarean.
• Decreased bowel function. The bowel sometimes slows down for several days after surgery, resulting in distention, bloating and discomfort.
• Respiratory complications. General anesthesia can sometimes lead to pneumonia.
• Longer hospital stay and recovery time. Three to five days in the hospital is the common length of stay, whereas it is less than one to three days for a vaginal birth.
• Reactions to anesthesia. The mother's health could be endangered by unexpected responses (such as blood pressure that drops quickly) to anesthesia or other medications during the surgery.
• Risk of additional surgeries. For example, hysterectomy, bladder repair, etc.
• Premature birth. If the due date was not accurately calculated, the baby could be delivered too early.
• Breathing problems. Babies born by cesarean are more likely to develop breathing problems such as transient tachypnea (abnormally fast breathing during the first few days after birth).
• Low Apgar scores. Babies born by cesarean sometimes have low Apgar scores. The low score can be an effect of the anesthesia and cesarean birth, or the baby may have been in distress to begin with. Or perhaps the baby was not stimulated as he or she would have been by vaginal birth.
• Fetal injury. Although rare, the surgeon can accidentally nick the baby while making the uterine incision.

As a mother who has had a cesarean section before, there is nothing fun about it. I cannot wrap my head around why any woman would make the informed choice to have major abdominal surgery instead of actually doing what their body was built to do. Birth babies.

The fact that our society thinks so lightly of this surgery, that it can compare the choice to choosing a flavor of ice cream screams the real problem with not only the maternity care system in this country, but the irresponsibility and ignorance of the patients, as well as the scary irresponsibility on the part of Obstetricians for allowing this serious procedure to be elective.

Place the blame on TV also.
Everytime you turn on a soap opera or nighttime medical drama, they are always making birthing women look like they are on the verge of death, and like they are going to blow up right there on the spot. What kind of message does that send to the uneducated next generation of mothers? BIRTH IS SCARY!
Turn on Special Delivery, or Maternity Ward, or that crappy show Deliver Me... and you see pregnancy and birth being treated as extremely dangerous and high risk events.
Why? Because those are the cases that get the ratings.

Chose what you will for birth.
But anyone has to question a mother for her choice to choose a risky and dangerous medical procedure to deliver her child instead of letting nature take its course.