By Dr. Rukmani Gopal
Indications for Elective C-section
- Elderly woman especially her first pregnancy is >35 years
- Women conceived after previous pregnancy losses
- Maternal Diabetes have adverse effect on the growing baby and require close fetal monitoring and timely C-section saves the baby
- Uterine Anomalies – Large & multiple Fibroid uterus, Double horn uterus, double uterus with a double vagina are invariably associated with malposition of the babies and C-section is done.
- Malpositions of the baby like complicated Breech, Transverse Lie, Twins when the first baby is not head down and Cord presentation are best dealt by C-section.
Emergency C-section is done in the following conditions:
- Hypertensive disorders of pregnancy has adverse effect on both the mother & baby with risk of convulsion and cerebral haemorrhage for the mother and justifies quick delivery if mother is not in imminent labour
- APH- bleeding during pregnancy >28 weeks. Abruption placenta -separation of the normally located placenta can be detrimental to the mother and quick and effective delivery prevents coagulation failure. Placenta praevia meaning placenta is low-lying and in the pathway, C-section is the best option
- CPD- When labour is prolonged due to an abnormal position like Occipito-posterior, deflexed head due to the cord around the neck especially when it is a sizable baby all resulting in non-progression of labour leading to maternal & fetal distress, resorting to C-section is a safe option.
- Fetal Distress-CTG graph findings show persistent late deceleration with a loss of beat to beat with variability and non-reactive NST are pointers of fetal distress more so when liquor is me conium stained baby has to quickly come out and delay is harmful so resorting to C-section is preferable.
- When an active phase of labour is unduly prolonged with absent membranes and Deep Transverse Arrest occurs it is safer to do emergency C-section.
Click here to read part 1 of this series- Childbirth in the past and present
When is Normal Labour possible?
Normal labour is still the preferred choice for many and women with low-risk pregnancy with head down position should be encouraged to go through the process of normal labour. It is best to wait for the spontaneous onset of labour pains since induction of labour increases the chance of ending up in C-section. Dawn should not rise twice upon the same labour as per Ian Donald and prolonged labour >24 hours is a matter of concern.
The first delivery is always a trial of labour for every woman and when they deliver normally, the obstruction is ruled out and subsequent birth is likely to be normal. When a woman is admitted for her first delivery –assessment of her pelvis & size of the baby and ruling out major disproportion are vital besides monitoring fetal heart rate. Long latent phase of labour is not abnormal and not a justification for C-section. During labour use of Bishop’s score & Partogram to assess the progress of labour are useful tools and every stage of labour must be closely monitored for complications and dealt with accordingly. CPD & Fetal distress are the two factors which are frequently manipulated and C-section rates could be curtailed by giving woman her first pregnancy maximum chance to have vaginal birth.
The attending physician need to have adequate experience to conduct normal labour and knowledge to intervene at the right time to save both the mother & child. Resorting to C-section without adequate trial of labour is a gross negligence. According to NHS UK C-section risk of death for the mother is 3 times that of the vaginal birth. Patients should be educated about the benefits of vaginal births and what to expect during labour.
Pic courtesy: huffpost
(This concludes Part 2 of the 3-part series on childbirth and C-section by Dr. Rukmani Gopal)