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Second Opinion 5

C-Section Panelists, Chris Glantz, Lisa Harris, Peter Salgo, Anna Sproul-Latimer

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The mission of the Geriatric Oncology Consortium (GOC) is to actively address age-based disparities in cancer research, education and treatment through a national, community-based program.
The goal of SIOG is to foster the development of health professionals in the field of geriatric oncology, in order to optimize treatment of older adults with cancer.
The Wilmot Cancer Center is organized around a multidisciplinary care model, which leading cancer experts believe is the gold standard in cancer care in the 21st Century.
Episode number: 
1201
Transcript: 
C-Section (transcript)

An estimated 4 million babies are born in the United States each year, and many moms have specific hopes for how their labor should go. Our patient Anna Sproul-Latimer shares the story of her high-risk pregnancy and the choices she made for the birth of her son.<--break- />

The following information source is from Mayo Clinic 

Cesarean delivery — also known as a C-section — is a surgical procedure used to deliver a baby through incisions in the mother's abdomen and uterus. A C-section might be planned ahead of time if you develop pregnancy complications or you've had a previous C-section and aren't considering vaginal birth after cesarean (VBAC). Often, however, the need for a first-time C-section doesn't become obvious until labor is underway.

If you're pregnant, knowing what to expect during a C-section — both during the procedure and afterward — can help you prepare.

Sometimes a C-section is safer for you or your baby than is a vaginal delivery. Your health care provider might recommend a C-section if:

  • Your labor isn't progressing. Stalled labor is one of the most common reasons for a C-section. Perhaps your cervix isn't opening enough despite strong contractions over several hours — or the baby's head is too big to pass through your birth canal.
  • Your baby isn't getting enough oxygen. If your health care provider is concerned about your baby's oxygen supply or changes in your baby's heartbeat, a C-section might be the best option.
  • Your baby or babies are in an abnormal position. A C-section might be the safest way to deliver the baby if his or her feet or buttocks enter the birth canal first (breech) or the baby is positioned side or shoulder first (transverse). When you're carrying multiple babies, it's common for one or more of the babies to be in an abnormal position.
  • You're carrying multiples. A C-section might be needed if the babies are being born early or if there are other problems.
  • There's a problem with your placenta. If the placenta covers the opening of your cervix (placenta previa), C-section might be the safest way to deliver the baby.
  • There's a problem with the umbilical cord. A C-section might be recommended if a loop of umbilical cord slips through your cervix ahead of your baby or if the cord is compressed by the uterus during contractions.
  • You have a health concern. A C-section might be recommended if you have health conditions, such as complex heart problems, high blood pressure requiring urgent delivery or an infection that could be passed to your baby during vaginal delivery — such as genital herpes or HIV.
  • Mechanical obstruction. You might need a C-section if you have a large fibroid obstructing the birth canal, a severely displaced pelvic fracture or your baby has severe hydrocephalus, a condition that can cause the head to be unusually large.
  • You've had a previous C-section. Depending on the type of uterine incision and other factors, it's often possible to attempt a vaginal birth after a previous C-section. In some cases, however, your health care provider might recommend a repeat C-section.

Some women request C-sections with their first babies — to avoid labor or the possible complications of vaginal birth or to take advantage of the convenience of a planned delivery. However, this is discouraged if you plan on having several children. Women who have multiple C-sections are at increased risk of placenta problems as well as heavy bleeding, which might require a hysterectomy. If you're considering a planned C-section for your first delivery, work with your health care provider to make the best decision for you and your baby.

Recovery from a C-section takes longer than does recovery from a vaginal birth. And like other types of major surgery, C-sections also carry risks.

Risks to your baby include:

  • Breathing problems. Babies born by scheduled C-section are more likely to develop transient tachypnea — a breathing problem marked by abnormally fast breathing during the first few days after birth. C-sections done before 39 weeks of pregnancy or without proof of the baby's lung maturity might increase the risk of other breathing problems, including respiratory distress syndrome — a condition that makes it difficult for the baby to breathe.
  • Surgical injury. Although rare, accidental nicks to the baby's skin can occur during surgery.

Risks to you include:

  • Inflammation and infection of the membrane lining the uterus. This condition — known as endometritis — can cause fever, foul-smelling vaginal discharge and uterine pain.
  • Increased bleeding. You're likely to lose more blood with a C-section than with a vaginal birth. However, transfusions are rarely needed.
  • Reactions to anesthesia. Adverse reactions to any type of anesthesia are possible. After a spinal block or combined epidural-spinal anesthesia — common types of anesthesia for C-sections — it's rare, but possible, to experience a severe headache when you're upright in the days after delivery.
  • Blood clots. The risk of developing a blood clot inside a vein — especially in the legs or pelvic organs — is greater after a C-section than after a vaginal delivery. If a blood clot travels to your lungs (pulmonary embolism), the damage can be life-threatening. Your health care team will take steps to prevent blood clots. You can help, too, by walking frequently soon after surgery.
  • Wound infection. Infections are more common with C-sections compared to vaginal deliveries. C-section infections are generally found around the incision site or within the uterus.
  • Surgical injury. Although rare, surgical injuries to nearby organs — such as the bladder — can occur during a C-section. Surgical injuries are more common if you have multiple C-sections. If there is a surgical injury during your C-section additional surgery might be needed.
  • Increased risks during future pregnancies. After a C-section, you face a higher risk of potentially serious complications in a subsequent pregnancy — including problems with the placenta — than you would after a vaginal delivery. The risk of uterine rupture, when the uterus tears open along the scar line from a prior C-section, is also higher if you attempt vaginal birth after C-section (VBAC).

Before your C-Section:

If your C-section is scheduled in advance, your health care provider might suggest talking with an anesthesiologist about any possible medical conditions that would increase your risk of anesthesia complications.

Your health care provider might also recommend certain blood tests before your C-section. These tests will provide information about your blood type and your level of hemoglobin — the main component of red blood cells. These details will be helpful to your health care team in the unlikely event that you need a blood transfusion during the C-section.

If your C-section is planned before 39 weeks for a non-emergency reason, your baby's lung maturity might be tested before the C-section. This is done with amniocentesis — a procedure in which a sample of the fluid that surrounds and protects the baby in the uterus (amniotic fluid) is removed from the uterus for testing. Maturity amniocentesis can offer assurance that the baby is ready for birth.

Even if you're planning a vaginal birth, it's important to prepare for the unexpected. Discuss the possibility of a C-section with your health care provider well before your due date. Ask questions, share your concerns and review the circumstances that might make a C-section the best option. In an emergency, your health care provider might not have time to explain the procedure or answer your questions in detail.

After a C-section, you'll need time to rest and recover. Consider recruiting help ahead of time for the weeks following the birth of your baby.

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