Normal Heart Rate And Respiratory Rate For 6 Month Old Relative Reasons For Cesarean Birth

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Relative Reasons For Cesarean Birth

One of the first things women often think about after a cesarean birth is… was it necessary. There are four cut and dried situations, where a surgical birth is absolutely necessary for the survival of the mother or the child or both. These are placenta previa, transverse presentation, severe cephalopelvic imbalance and prolapsed cord in the first stage of labor. But in addition to these four conditions there is a gray area where a cesarean could be very good for the mother and the child. These conditions should be fully discussed with your doctor. You may even want to get a second opinion to make sure you are comfortable with your choice. Or you can just trust that your doctor wants the best for you and your baby. These conditions are much more common and the reason for most cesareans.

Relative cephalopelvic inequality: Unlike true CPD where you cannot deliver a baby vacuum, relative CPD means you cannot deliver this baby vacuum. Relative CPD is usually diagnosed after you’ve been in labor for a while and your doctor has given your body a chance to deliver your baby on a vacuum.

There are a couple of reasons for this. First, this baby may just be too big for your pelvis. My first caesarean was for this reason; my son was almost ten pounds. I spent five years angry at my doctor and feeling like a failure. But with my second VBAC, his brother who was a little smaller got stuck at the shoulders (shoulder dystocia), a serious crisis. In that time, I had access to so few women who have the gift of returning to know that my cesarean was absolutely necessary. I had successfully delivered an eight pound baby successfully, but my pelvis was not big enough to accommodate a nine or ten pound baby. There are a couple of thoughts you may have about CPD that are relevant to you: 1) Your baby’s head will never go into your pelvis. You may hear your doctor or midwife talk about your baby being in a negative station. 2) Ultrasound can sometimes be used to estimate the size of your baby. Note that this is not always correct. And this is a friendly matter; while my sons had difficulty passing through my pelvis I had a friend who delivered eleven children with ease.

The second reason for relative CPD is covered in more detail below.

Abuse: In order for your baby’s head to pass through your pelvis, the smallest diameter of his head must be compatible with the largest diameter of your pelvis. The best position for this is when his chin is attached to his chest. But sometimes a baby tilts his head back as if he were looking up (called an eyebrow show). This makes it much more difficult for the head to pass through the narrow opening of the pelvis.

Likewise, the best position for early labor is for the baby’s face to be in front of your bottom. This is because the front is softer and can press more easily through the pelvis. But if the hard back of the baby’s head is pressed against your spine, called occiput posterior (OP), you can experience very painful and slow labor. This intense pain is caused by rubbing the two hard surfaces together. Labor can be slower because in this position as in relative CPD the baby’s head is not in direct contact with your cervix, which means the head is not putting pressure on the cervix opening.

Remember that miscarriage is not an absolute indication for a cesarean birth. Sometimes the baby’s position will change during labor and sometimes you or your healthcare provider can use techniques to change your baby’s position. But also, there are times when none of that works. My second cesarean birth was due to OP. I had wonderful and supportive midwives. I tried all the common remedies to relieve the pain and speed up labor (the shower, walking, back massage) and nothing worked. I never for one moment doubted that this cesarean was necessary because I knew I had reached my limit.

Breech position: Closely related to malpractice is the position where the baby is turned so that its bottom rather than its head is the presenting part. There is a greater risk of the baby getting stuck in the birth canal, if the head is bigger than the bottom. For this reason, many doctors believe that it is safer to deliver by surgery. A couple of things to consider though is that the baby can change position either before or during labor. Sometimes even babies can be encouraged to move through a process called external version, but it is important that this is only attempted by trained medical staff under close supervision. Even if the baby’s condition does not change, it is still possible to have a natural birth. But this should be a decision made by your medical team. You may even need to seek out a caregiver with more experience in breech deliveries.

Maternal fatigue: Reaching your limits is another indication for a cesarean. Sometimes we just can’t go on. Did we fail somehow? No, we tried our best and then used the help available to do what was best for us and our babies. Every woman and every labor has different limits. It is common for all women to reach this stage during labour. It is usually a sign that her cervix is ​​almost completely dilated and that her baby will be born soon. But if you have reached this point and you are still likely to be several hours from birth, discuss your options with your midwife or doctor.

Failure to progress: Known as labor dystocia, this term has strong emotional associations…failure to progress. Yes it really means that for some reason your body is not working in a way that the doctor or midwife considers normal. By itself this is probably the weakest indication for cesarean. But labor dystocia is often seen along with maternal distress or fetal distress (which we’ll talk about next). These then become key indicators.

Fetal distress: Fetal distress is one of the most common reasons for cesarean delivery. Fetal distress is usually suggested by changes in the baby’s heart rate on monitors. In the last twenty-five years, the use of monitoring equipment has increased significantly during labor and with the caesarean section. Common changes that may indicate distress are beating too fast (tachycardia) or too slowly (bradycardia). Another common pattern is called late loading. It is common for the baby’s heart rate to slow during contractions, but it will come back once the contraction is over. In late acceleration, the heart rate rises slowly or not at all. The thing to remember with fetal distress is that sometimes a baby diagnosed with distress is born without any problems. But as parents except in the worst case scenario you have to weigh the risks of continuing to work against the risks to your child.

Second degree prolapsed cord: Similar to the earlier discussion of cord prolapse, this is a very serious and dangerous condition for your baby. But if you are fully dilated and already pushing sometimes your doctor may feel it would be better to do an episiotomy (cut between the vagina and anus) and either forceps or a vacuum extractor use It is often a question that the doctor feels will get your baby out the fastest in this emergency situation.

Past obstetric history (previous cesareans): In 1986, when I had my first cesarean I was told that I would always have to have my babies by cesarean. Today though there is enough research that shows that Vaginal Birth After cesarean (VBAC) is not only safe, but it is often better for the mother and the baby. The reason for the old saying once a cesarean always a cesarean was the fear that the previous scar would separate during labor. Research however has shown that this is very rare. As a result, many doctors are now encouraging their clients to deliver subsequent babies by vacuum. Many women who have a cesarean often want a vaginal birth with future pregnancies as well. If this is the case, the first step is to carefully choose a doctor or midwife who is experienced in VBACs and a VBAC-friendly birthing place.

Elective birth: An increasing number of women are choosing elective cesarean birth either after a traumatic first birth or because of deep concerns about the safety of their baby. Although it is your medical provider’s responsibility to provide you with all the information and obtain your informed consent, remember that it is still your decision and ultimately only your choice to make. This is a very personal decision and you should make it with your doctor.

If you find yourself facing any of these situations during or before labor, a good question to ask is…do we have time to talk about it? This question will give you an indication of how serious the doctor feels the condition has become. If the answer is yes, then a good follow-up question is… what happens if we do nothing at this point? Your doctor may feel comfortable with changing your position and watching to see if the situation improves. But this is your baby and you may feel that the best way is to follow your doctor’s advice immediately.

But as I said at the beginning of this article, these conditions are relative. They are about pro’s and con’s, weighing options, and deciding what is best for you and your baby in your particular situation. While your medical team can and should offer expert guidance, ultimately you are in the best position to decide what is best for you and your child. But also remember that you always take personal responsibility for the choices you make. This is just the first of many difficult and sometimes life and death decisions you will have to make on behalf of your child in the years to come.

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