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Spring 2018
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high variation of
labor
management by physicians, and the fear of medical liability in the obstetrics community. when you add the high rate of repeat c-sections to the mix, the overall rate rises well over 30 percent across most of the country.? some reasons women may require a c-section include the baby's position in the uterus, the size of the baby, premature
delivery
, fetal heart rate changes indicating a lack of oxygen during
labor
, or if there?s a medical complication with the mother like preeclampsia or gestational diabetes. what about vbac? while many ob/gyns are proponents of a
vaginal
birth a?er a c-section (vbac), they say it's important to consider the reasons behind a previous c-section and the risks of vbac. for example, if your previous c-section was due to your baby being in a breech position, you might be an excellent candidate for vbac. ?most women who have had one previous c-section are candidates for
labor
and
vaginal
delivery
attempt in the next pregnancy. as long as the previous uterine scar is across the lower part of the uterus, the risk is low that the uterus will tear with the next
labor
. if the uterine scar is vertical (extends from the lower part to the upper part of the uterus), then there is an increase danger of uterine tearing with
labor
,? says dr. dauterive. ?even patients with two previous low transverse c-sections are potential candidates for a monitored
labor
with
vaginal
delivery
. one of the factors preventing trials of
labor
in previous c-sections is the requirement to have a physician capable of performing an emergent c-section in the hospital during the
labor
.? what are the risks? tears and lacerations can occur during any
vaginal
delivery
. although rare, uterine rupture is a life- threatening risk factor, particularly for women who opt for a vbac. a uterine rupture is a tear in the wall of the uterus, usually at the site of a past c-section incision. the incidence rate is about one percent for women who have had low-transverse incisions, rising to five percent for women with vertical incisions. c-section risks include blood loss and complications with anesthesia, as well as scarring and infections. how long is the hospital stay? the typical hospital stay for a
vaginal
delivery
is 24-48 hours, while a c-section is between three and four days. what about recovery? whether you?ve had a
vaginal
delivery
or a c-section, always follow your doctor?s recommendations. generally, a woman who delivers
vaginal
ly has no restrictions on li?ing and can typically return to her normal routine within a few weeks. with a c-section, expect the recovery to take a little longer as your mobility is more restricted. other than your baby, you won?t be able to li? anything over 10 pounds, and due to the pain medicines, you cannot drive for the first two weeks post surgery. dr. dauterive explains, ?c-sections are major abdominal surgery. the wound represents a relatively large incision of the fascia (the main supporting layer of the abdominal wall) and requires some time to achieve enough strength to prevent an opening and herniation of the incision. therefore, activity that requires pushing and li?ing should be limited. also, there is a certain amount of postoperative pain that can come on suddenly. my concern with driving comes if there is sudden pain at a crucial time, like when you need to hit the brakes. therefore, we generally limit driving until the patient is pain free for several days. this generally takes two weeks, and if significant physical activity is necessary, then at least six weeks is required to have enough strength in the incision to prevent a complication.? even if you?ve had a c-section and you?re on pain medications, breastfeeding is safe and encouraged. contact your physician immediately if you experience fever, uncontrolled pain, bleeding, or incisional problems. who will be postpartum support? during the first few weeks postpartum, lean on your partner, a family member, or a close friend for emotional support and practical assistance, especially if you have other children. new dads can help direct visitors and ensure that you get the privacy and rest that you need. contact your physician right away if you experience excessive blues which could be a sign of postpartum depression, a serious, but common issue among new mothers. s p r i n g 2 018 | p i n k ? b l u e 31
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