Re: elective caesarean section delivery
From: Kelly (anonymous@obgyn.net)
Tue, 13 May 1997 23:48:25 -0500 (CDT)
At Tue, 13 May 1997, D. Ashley Hill, M.D. wrote:
>This is a common issue in Ob/Gyn. The old adage "once a cesarean,
>always a cesarean" is simply no longer valid. Although there is a
>slight chance of uterine scar dehiscence (where the former incision on
>the uterine wall opens up during labor), this event has an incidence of
>only about 1/2 of 1%. Even then, the majority of moms and babies do
>fine, although an emergency c/section is often necessary. This is
>balanced by the medical fact that vaginal delivery is almost always
>safer than a major abdominal operation.
>
>Most patients are unaware of the significant risks of bleeding,
>infection, abdominal scar breakdown, postop pain, and potention bladder
>damage and scar tissue formation that can occur with a big operation
>like a c/section. True, most go quite well, but I guarantee every
>single Ob/Gyn on this group has seen otherwise routine c/sections go
>downhill rapidly! I consider the average c/section to be more dangerous
>than the average hysterectomy, as there is almost always more blood loss
>and infection. Patients don't always see this, and many really push
>their doctor for one, but if there are complications the inevitable
>statement is "I sure wish I hadn't had a c/section". The statement "but
>I did great after the first c/section" is common, but not necessarily
>statistically valid, since each additional surgery is more difficult. In
>addition, most babies come out of vaginal deliveries crying or at least
>breathing well, whereas with a c/section (at least at our hospital) we
>are required to have a respiratory team there to stimulate the baby,
>since many don't breath as well after a c/section. This is probably
>because the vaginal walls squeeze fluid from the lungs during a vaginal
>delivery, making it easier to breath at first.
>
>However, not all VBAC attempts go well, either. As one medical journal
>article said "VBAC: low risk, not no risk"! Some result in a c/section
>anyway, which is frustrating for everyone. The overall chance of
>delivering vaginally after a prior c/section is *about* 75-80%, which
>are pretty good odds. Even fewer result in a uterine scar breakdown,
>requiring emergent delivery. The final decision must be yours, and you
>should feel comfortable with your doctor and his or her advice. This is
>part of the all-important informed consent process, where you get the
>information and opinion from your doctor or other health care provider
>about the risks/benefits of *any* procedure, including a VBAC. Once you
>make the decision, either way, you should receive full support from the
>medical staff.
I have to echo everything Dr Hill said -- he did a great job giving you
the important facts you need to make an *informed* decision. Now that
you know all the issues, whatever decsion you make will be the right
decision, because it was not made blindly.
I have one question for you: if you don't like and trust your current
doctor ( a doctor who won't answer your questions and who always makes
you feel rushed), why don't you switch?
--
Kelly Shanahan, MD, FACOG
S. Lake Tahoe, CA
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