April Is Cesarean Awareness Month
“Going past your due date is not a valid reason for a Cesarean Section. In fact, a majority of first time mothers will go up to 10 days past their due dates.”
“Having a previous Cesarean Section is NOT an indication for a Repeat Cesarean Section. In fact, if otherwise healthy, most mothers if given time, space, privacy, patience, and good monitoring and excellent support, can indeed go on to have a completely natural birth.”
When trying for a normal delivery after a previous C-section, what women and their families need is good transparent discussions about pros and cons of having a VBAC (Vaginal Birth After Cesarean) in the antenatal period, and mental and physical preparation for the process of labor and birth. They also need care providers who truly believe in the power of natural birth, and who walk the talk – ICAN and other organizations recommend that women choose care providers who have more than 70% VBAC success rates, in order to boost their chances of having a VBAC. We at Healthy Mother have a 86% VBAc success rate!
“Having low amniotic fluid is NOT a reason for an immediate Cesarean Section.”
Different women have differing levels of amniotic fluid. Different radiologists measure it differently. Sometimes, we have seen that the same radiologist will get somewhat differing results on consecutive days with respect to exact AFI (Amniotic Fluid Index)!! What we do know is that extreme decrease in amniotic fluid is not that common, in a healthy, otherwise well-nourished woman. If fluid levels are drastically low, Mom can notice it with the quality of baby movements, and care-providers will notice it while monitoring baby’s heart beat. If the baby’s heartbeat is non-reassuring, then and only then interventions may be needed. Otherwise, the wise thing to do would be to wait and watch and monitor and let labor start and progress on its own. If baby does not tolerate the stress of labor, then again interventions are an option, otherwise most moms will be able to have their baby naturally! In practice, we see babies being born with teaspoons of amniotic fluid, a waterfall of fluid, and most somewhere in between – and most of them tolerate labor just fine!! In fact, unless we are seeing some physical signs that seem to be out of the range of normal, we at Healthy Mother, almost never do ultrasounds in late pregnancy, and definitely not to measure fluid volumes!!
“Having your bag of waters break is not a reason for an immediate Cesarean Section.”
For 6-8% of women worldwide, labor will start with the bag of waters breaking or releasing. For some it will be a trickle. For others it will be gushes and later some trickles. For yet others, there might be small amount of water trickle only while changing positions or walking.
For many women, once the bag of waters breaks, labor will start within the first hour or two. 60%-70% of women will go into labor spontaneously within 24 hours and over 91% within 48 hours. Only 6% remain pregnant beyond 96 hours.
If the baby is full-term (37 weeks or more), it makes sense therefore to wait AT LEAST 24 hours after the bag of waters breaks, before offering ANY intervention. Even after 24 hours, after discussing pros and cons of waiting (yes, there is more increase in risk of infection to the baby every 24 hours after the bag of waters breaks, but options and choices of giving antibiotics to mom, and other pros and cons must be discussed), giving a good trial of labor by induction should be a part of the plan of care, unless mother or baby seem to be at increased risk.
After 72 hours of bag of waters breaking, even then if mom has not gone into labor, induction of labor should be strongly recommended. Women should be told signs to look out for and report – color of fluid, baby movements, any foul smelling discharge, any increase in maternal temperature, and of course anything that does not feel right to mom. Another thing: Avoiding internal exams until good active labor sets in will minimize infection risk. Baby will not fall out without good contractions of active labor 🙂 🙂
Finally, not letting the mom get up and move, or telling her that ALL her water will leak out, or there will be Dry Labor, makes no sense because the body (and her baby) participate in producing fluid constantly. If mom is kept on the bed, how will her baby descend and participate in the dance that labor is?? Mom should also be told to keep herself well-hydrated.
And, in case something is off, there are tests. Non stress tests can be done every 24 hours to see how baby is doing. Baby’s heart beat can be monitored. As long as mom and baby are well, it is prudent to wait and watch, and proceed step-by-step, with good informed consent, rather than to tell the mom “it is your risk” and go in for immediate C-section – As partners in care, we can do better!
Stay tuned for Part 2 of Cesarean Awareness Tips!
Learn. Share your stories. Were you “allowed” to go past your due date? Were you induced? Did you have a normal delivery with induction, or did it lead to a C-section? Did you get induced because you had less amniotic fluid? Were you “allowed” to wait for labor to start after your bag of waters broke? Were you “allowed” to try for a normal delivery after previous Cesarean Section?
It is your body, It is your baby. Be Informed. Be Empowered.