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1993-06-14
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$Unique_ID{PAR00440}
$Pretitle{}
$Title{Pregnancy: The Ninth Month: Ask the Doctor}
$Subtitle{}
$Author{
Editors of Consumer Guide
Ellis, Jeffrey W
Ellis, Maria}
$Subject{Ninth Month Ask Doctor Cesarean Section Sections vaginal delivery
problem umbilical cord infection injury breech birth placenta previa classic
lower segment incision labor surgery operation}
$Log{
Cesarean Section*0044001.tif}
Miracle of Birth
The Ninth Month: Ask the Doctor
Will I Need a Cesarean Section?
While the majority of babies born in the United States are delivered
vaginally, about 15 to 20 percent are delivered by cesarean section. Cesarean
section is the delivery of a baby by cutting through the mother's abdominal
wall and uterus and removing the baby from the mother's body through these
incisions.
A cesarean section may be performed for many reasons. In general, a
cesarean section is performed when a vaginal delivery would cause injury to
either the mother or the baby. For example, a cesarean section may be
performed in order to:
- Save the baby's life when a problem with the placenta or the umbilical
cord is cutting off the blood supply to the baby. An abnormal heart
rate in the baby, which is usually detected with a fetal monitor (see
Labor and Delivery, Factors that Influence Your Delivery), may indicate
that such a problem has developed.
- Deliver the baby if the mother fails to give birth vaginally after a long
labor. This usually occurs because the baby is simply too big to pass
through the mother's pelvis.
- Prevent infection of the baby when dangerous bacteria are present in the
amniotic fluid or when a potentially dangerous vaginal or cervical
infection, such as herpes, is present in the mother.
- Prevent injury to the baby during a breech birth (when the baby would
emerge through the vagina with her buttocks or feet first rather than in
the usual head-first position). Many obstetricians believe that all
breech births in first-time mothers and all premature breech births
should be done by cesarean section.
- Treat a disease or condition in the mother or baby that can be treated
more successfully if birth occurs as soon as possible.
- Prevent the possibility that the uterus may rupture during labor in a
woman who had a cesarean section with a previous baby.
- Deliver three or more babies in a multiple pregnancy.
There are two types of cesarean section, each used for a particular
reason. In the classic cesarean section, the doctor makes a vertical incision
in the mother's abdomen from her navel to her pubic bone; the thick upper
portion of the uterus, which lies beneath the skin of the upper abdomen, is
also cut vertically down the center.
The classic cesarean section is generally used only if the baby is lying
in an abnormal position or if the placenta is in an abnormally low position in
the uterus (placenta previa). With this type of cesarean section, there is
more bleeding than with other methods, it is more difficult for the doctor to
repair the incision, and the uterus is more likely to rupture during a future
pregnancy. For these reasons, the classic cesarean section is seldom used
today unless absolutely necessary.
The lower segment cesarean section is the more commonly performed
operation. Here, the doctor makes an incision--either vertically or in a
smile-shape--through the lower part of the abdomen and the lower, thinner
portion of the uterus.
In the past, a firm rule in obstetrics was "once a section, always a
section," because of the fear that the uterus would rupture if a vaginal
delivery were attempted in a subsequent pregnancy. More recently, however,
obstetricians have found that many women who have had a previous cesarean
section can have a safe vaginal delivery in a subsequent pregnancy. If you
have already had a baby by cesarean section, you may want to ask your doctor
if it is possible for you to attempt a vaginal delivery.
Sometimes, it is necessary for a cesarean section to be performed before
a woman actually goes into labor. In most cases, however, the doctor does not
know if a cesarean section will be needed until the woman is in labor. There
is really nothing that you can do before labor to prevent the need for a
cesarean section.
Today, cesarean section is an extremely safe operation because of
improved antibiotics and better anesthetic medications. While you may not
relish the thought of having a cesarean section, you should keep in mind that
if a serious complication arises during labor, a cesarean section may be
necessary to ensure the health and safety of both you and your baby.
This Month's Visit
During this month's office visit, your doctor will probably:
- Check your weight. By now, you will have gained about 22 to 28 pounds.
- Check your blood pressure. Your blood pressure should remain normal. If
it is elevated, you may be developing preeclampsia.
- Ask about symptoms of pregnancy. By now, you may have experienced
lightening, an increase in vaginal discharge, passage of the mucous plug,
and an increase in the frequency of Braxton Hicks contractions.
- Ask how you are feeling. Be certain to report any dizziness, blurred
vision, headaches, or swelling of the face and hands, since these may be
signs of preeclampsia.
- Ask about the baby's movements. The baby should be moving vigorously; if
you ever feel that your baby is moving less than usual, inform your
doctor immediately.
- Check the growth of your uterus with a tape measure. Since the baby may
have dropped lower in your uterus, the top of the uterus itself may now
be a few inches below your breastbone.
- Listen for the baby's heartbeat with a doppler instrument or a
stethoscope. The baby's heart will now beat about 120 to 140 times per
minute.
- Check the position of the baby by feeling the uterus.
- Do a pelvic examination to check if the cervix is dilating (opening) or
effacing (thinning out).
- Perform no new tests.