Cesarean Surgery

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Cesarean Surgery
Ceridwen Morris:
What can you request from your care-provider to make a cesarean birth more mother and baby-friendly? - Thanks, Ceridwen

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RE: Cesarean Surgery
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Henci Goer:
The International Cesarean Awareness Network has a great webpage on this issue at http://ican-online.org/pregnancy/family-centered-cesarean.

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RE: Cesarean Surgery
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Lynda Hay:
Is delayed cord clamping a reasonable request for surgery. What might be some reasons for refusal and what is the evidence?

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RE: Cesarean Surgery
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Fans of birth activist Henci Goer:
@ Lynda
I am not a doctor or midwife, but it seems to me there would be no reason why early cord clamping would be needed at a cesarean delivery any more than it is at a vaginal birth. In fact, if the reason for the cesarean were that the baby was in trouble, early cord clamping could make a bad situation worse by depriving the baby of a substantial proportion of its blood supply and of continuing oxygenation via maternal circulation, which would create a margin of safety until the baby got up to speed with breathing.

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RE: Cesarean Surgery
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Ben N Alicia Thompson:
What are the actual statistic percentages for uterine rupture during VBAC after one cesarean and after two cesareans?

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RE: Cesarean Surgery
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Henci Goer:
@ David
Thanks for this correction. The "natural cesarean" people describe delivering the head and waiting, which allows the baby to begin breathing while its torso "tamponades the uterine incision, minimizing bleeding" (p. 1038) http://www.ncbi.nlm.nih.gov/pubmed?term=smith+2008+natural+caesarean. Once the baby begins breathing, the reduced resistance in the lungs would switch over the baby's blood circulation from fetal mode to newborn mode and that, combined with rising blood oxygen levels, would shut down circulation to the placenta just as it does after vaginal birth. With this strategy, immediate cord clamping after delivery would no longer pose a problem. Opinion?

I'm also curious what your reasons are for delayed cord clamping.

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RE: Cesarean Surgery
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David Hayes:
Henci,
I'm a big fan, homebirth obstetrician, consistently maintained a C/S rate of less than 1%, etc. etc. but I doubt you will find any obstetrician that will delay cord clamping during C/S. You have the uterus cut wide open and bleeding freely. I'm pretty sure no one will trade massive maternal blood loss for more time with an intact umbilical cord. Even I wouldn't.
BTW - I'm also a big supporter of delayed cord clamping, but for very different reasons than are commonly sited by supporters. I'd love to have that discussion with you sometime.

David Hayes

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RE: Cesarean Surgery
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Henci Goer:
@ Ben N Alicia
I've pasted in the results and conclusion of a systematic review of VBAC outcomes after 2 prior c/secs compared with after one and with outcomes after a 2nd repeat cesarean. Overall, 5666 women planned VBAC after two cesareans. Furthermore, likelihood of scar rupture depends on modifiable factors such as whether labor was induced or augmented. I would bet that with optimal care, rates would have been lower in both categories.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19781046

MAIN RESULTS: VBAC-2 success rate was 71.1%, uterine rupture rate 1.36%, hysterectomy rate 0.55%, blood transfusion 2.01%, neonatal unit admission rate 7.78% and perinatal asphyxial injury/death 0.09%. VBAC-2 versus VBAC-1 success rates were 4064/5666 (71.1%) versus 38 814/50 685 (76.5%) (P < 0.001); associated uterine rupture rate 1.59% versus 0.72% (P < 0.001) and hysterectomy rates were 0.56% versus 0.19% (P = 0.001) respectively. Comparing VBAC-2 versus RCS, the hysterectomy rates were 0.40% versus 0.63% (P = 0.63), transfusion 1.68% versus 1.67% (P = 0.86) and febrile morbidity 6.03% versus 6.39%, respectively (P = 0.27). Maternal morbidity of VBAC-2 was comparable to RCS. Neonatal morbidity data were too limited to draw valid conclusions, however, no significant differences were indicated in VBAC-2, VBAC-1 and RCS groups in NNU admission rates and asphyxial injury/neonatal death rates (Mantel-Haenszel). CONCLUSIONS: Women requesting for a trial of vaginal delivery after two caesarean sections should be counselled appropriately considering available data of success rate 71.1%, uterine rupture rate 1.36% and of a comparative maternal morbidity with repeat CS option.

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RE: Cesarean Surgery
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Elizabeth Glazier Mims:
My daughter was born by c-section after a failed induction, and I didn't seriously (despite having a strong feeling beforehand that I had just doomed myself to a c-section as soon as I agreed to the induction) consider that I wouldn't have a vaginal birth until I was signing the surgical consent forms. I am the type of person who tends to research things to death, but I knew almost nothing about a c-section going in other than they usually used a low transverse incision, and that regional anesthesia would allow me to be awake and my husband to be present.
While my husband and I aren't yet ready to seriously think about another baby (our daughter's only 8 months old) I already know that I definitely want a VBAC, but naturally when I think about another child the idea of having a c-section again weighs on my mind. So my question is, what advice do you have for women (either VBAC or non prior-Cesarean) on preparing for an unplanned c-section? Thank you very much!

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RE: Cesarean Surgery
(in response to Archived User)
Henci Goer:
@Elizabeth
My response to Ceridwen above has a link to an ICAN webpage on planning a family-centered cesarean. That should get you started.

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