How to prevent C Section
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Avoiding Unnecessary C Section
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Protecting the new Moms ( 1st time) from C section
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The science is advancing,we are moving away from conventional open surgery to laparoscopic surgery to robotic surgery.We want smaller cuts for uterus removal ovarian cysts,,fibroid removal but what are we doing for delivery? We are going away from vaginal deliveries towards big scars of cesarean deliveries. Once a cesarean,there are 80% chances of having a 2nd cesarean also & if 3rd pregnancy occurs- 3rd is inevitably an indication for elective cesarean section.The chances of having laparoscopic or robotic hysterectomies are minimized case if required at later age.
When the girl is young ,about to be a mom, needs to have less trauma to body & maintain her figure, we give her big scars of cesarean section & when she is old of 45 & needs hysterectomy, we try to manipulate her by giving smalls scars of laproscopic surgery or robotic surgery ( through small holes)
The uses of robotic surgery is undoubtedly good as it leads to faster recovery but why the C- section rates are going so high.
C section is a major surgery and carries risk for infection ,bladder and bowel injuries,serious complications for future pregnancy like aldherent placenta ,bleeding per vaginum during pregnancy & more chances of 2nd cesarean & hysterectomies.
Justified Indication of C - section are -
1) breech presentation or oblique lie.
2) low lying placenta or placenta previa
3)pre eclampsia/eaclampsia
4) multiple pregnancy with first breech or transverse lie
5)big sized babies leading to shoulder dystocia.
6) Cpd
Unjustified indication of C section are
a) Fear of labor pains thus avoiding vaginal deleiveries.
b) wanting to have baby at auspicious moments e.g janmashtami and guru purab. Or at specific date & time as guided by astrologers.
c) patient on continuous fetal heart monitoring showed single reading of dropping fetal heart rate during labor pain.
d) if having insurance coverage are more likely to undergo C-section.
f) for convenience of doctor as C-section is less time consuming and more profitable.
g) lack of availiblity of obstetrician and anaesthetist round the clock.
h) fear of medicolegal litigations.
Things to be done by Mom to prevents C -section
a) Avoid unnecessary weight gain. Averege weight gain of 11-13 kg during pregnancy will give you an average baby wt of 2.5 – 3.1 kg. A weight gain of more than 15 kg will give you macrosomic baby. An average indian women with average height of 5feet 3 inches cannot delivers a baby of more then 3.6-3.8 kg ,so avoid unnecessary weight gain during pregnancy by modifying your dietery patterns i.e more of protiens and reduce carbohydrates intake.
b) Exercise – working women having sedentary job should exercise more or attend antenatal classes.
c) Shortning the period of rest & sleep to not more than 8 hrs. in a day.
d) Pregnancy is a physiological state & not a disease does not require bed-rest. Working actually throughout your pregnancy unless otherwise indicated in cases of high blood pressure or low lying placenta gives you more chance of having vaginal deleivery.
e) Avoiding white flour and maida in,pitza,pasta & chowmein & pure starches like potato & rice.
f) Doing more of household works.
g) Attend antinatal classes to learn more about exercises ,diet & nutrition labor pains & delievery
h) Being patient & cooperative during labor
i) Having a good support during labor like doula
THINGS TO BE DONE BY A DOCTOR TO AVOID C-SECTION
Choosing a Coregiver/ Doctor – ask your doctor about What is her rate of primary cesarean sections—which should be as low as 10%. Ask about the places where she takes her clients for birthing & inquire about hospital policies for labor birth care & find out the c section rates.
Before marrying a man,we survey all his particulars , his family & financial status but some patients do little research about the doctor and go by the fact which doctor has a big name, does more publicity and more by word of mouth references.Most of the popular doctor gives undesirable or very high cesarean rates.
This is where the difference lies between an unskilled & well trained obstetrician.If the obstetrician is well trained in good premiere institution, where she has conducted a good number of delivery including forceps ,vaccum,rotation of occiput in occipitoposterior position,she is confidant enough to handle such complicated vaginal deleiveries and she is confident enough to do cesarean in of deep stuck head ( if trial fails) ,unnecessary c section rate can be significantly diminished.
CHOOSING A BIRTHING PLACE ask about the fascilities like epidural anaesthesia, nursery & blood bank in the hospital. Most of the hospitals do not collect the data for vaginal cesarean delivery ratio and moreover they are not transparent about the data for individual doctor’s vaginal to cesarean ratio. The data collection should be transparent as it attribute for the patient to choose their obstetrician.
INDUCTION OF LABOR Studies have shown that at less then 40 weeks of gestation women who underwant induction have lower rate of c section compare to those who received expectant management.Use of cerrvical ripening methods such as misopristol,dinoprostgel or pge 2 gel. foleys bulbsand laminaria tents lead to lower rate of c section.
b) If colourd doppler studies is normal ,the baby weight is within normal range & the mother is feeling good fetal movements & the cervix is unfavourable,do not induce the labor before 40 weeks unless medically indicated
c)wait for 24 Hours to call it as failed induction .
d) in case of ruptured membranes wait for 12 -14 hrs. of induction
LABOR SUPPORT – it is the most effective tool to improve labor and delivery outcome as continuous presence of one to one personnel support such as doula improves patient satisfaction and co operation ,this resource is underutilized .Doulas are schooled to give massage,positioning,
Cesarean section are required If second stage is prolonged that is more than 3 hours or 4 hours in cases of epidural analgesia, operative vaginal delivery like foreceps or vacuum delivery should be used judiciously as they do not have serious morbidity like intracerebral haemrrhage. Hopefully the combine efforts of the doctor and patient would definitely reduce the Ceserean Section rate.
