What to expect when you're expecting (129 page)

A prolapsed umbilical cord

A ruptured uterus

If your practitioner says that a C-section will be necessary—or will probably be necessary—ask for a detailed explanation of the reasons. Ask, too, if any alternatives are open to you.

“I’ve heard some women say they chose to have a C-section—is that something I should consider, too?”

Cesareans on demand may be more in demand than ever these days, but that doesn’t mean you should sign up for yours. Opting for a surgical delivery when one isn’t medically necessary isn’t a decision you should take lightly (and definitely one you shouldn’t base on trends). It deserves careful consideration—and plenty of discussion with your practitioner about the potential pros and cons.

Though you might have plenty of reasons for wanting a C-section, make sure you consider both sides of the equation. If you’re …

… scared about the pain of a vaginal birth,
keep in mind that electing to have a C-section isn’t the only way to deliver without pain. There are many effective pain-relief options available to women having a vaginal birth (see
page 302
).

… worried about the aftereffects of a
vaginal birth, like pelvic wear and tear or lax vaginal muscles, remember that regular pelvic floor exercises (aka Kegels) can significantly reduce the risk of those effects. What’s more, a vaginal birth isn’t any more likely to leave you with urinary incontinence issues than a C-section is (which means your baby’s exit route doesn’t impact the chances that you’ll spring a leak postpartum).

Scheduled Classes for Scheduled C’s

Think a scheduled C-section means you won’t have to schedule childbirth classes? Not so fast. Sure, you won’t need to become an expert on breathing exercises or pushing techniques, but childbirth education classes still have plenty to offer you and your coach (including plenty on what to expect with a C-section—and with an epidural). Most classes also offer invaluable advice on taking care of your baby (which you’ll have to master no matter which exit your baby takes), breastfeeding, and possibly getting back into shape postpartum. And don’t tune out when the teacher’s going over the labor breathing routine with the other students. You might find those skills come in handy postpartum when you’re confronted with afterpains (as your uterus contracts back to its original size) or when baby’s trying to feed off your painfully engorged breasts. Relaxation techniques also help all new moms (and dads).

… hoping to give birth when it’s convenient
for you, be sure you also consider the longer recovery time and hospital stay plus the increased risk from surgery for you and your baby if you select a C-section. That’s not exactly convenient.

… going to have another baby,
understand that opting for a C-section now may limit your options next time around. Some doctors and hospitals limit VBACs (vaginal births after cesarean) these days, which means you might not be able to choose a vaginal birth for your second baby, if you decide later on that C-sections aren’t for you after all.

Something else to consider when contemplating a scheduled cesarean that’s not medically necessary: The best time for your baby to make his or her exit from your uterus is when he or she is ready. When an elective delivery is planned, there’s always the possibility that the baby will inadvertently be born too soon (particularly if the dates are off to begin with).

If, after careful consideration, you’re still interested in signing up for an elective cesarean delivery, talk with your practitioner and decide together whether it’s the choice that’s right for you and your baby.

“I’ve had two cesareans and want to go for my third—and maybe my fourth child. Is there a limit on the number of C-sections you can have?”

Thinking of having lots of babies—but not sure whether you’ll be allowed to make multiple trips to the hospital’s happiest operating room? Chances are you’ll be able to. Limits are no longer arbitrarily placed on the number of cesarean deliveries a woman can undergo, and having numerous cesareans is generally considered a much safer option than it once was. Just how safe depends on the type of incision made during the previous surgeries, as well as on the scars that are formed following the procedures, so discuss the particulars in your case with your practitioner.

Depending on how many incisions you’ve had, where you’ve had them, and how they’ve healed, multiple C-sections can put you at somewhat higher risk for certain complications. These include uterine rupture, placenta previa (a low-lying placenta), and placenta accreta (an abnormally attached placenta). So
you’ll need to be particularly alert for any bright red bleeding during your pregnancies, as well as the signs of oncoming labor (contractions, bloody show, ruptured membranes). If any of these occur, notify your practitioner right away.

“I had my last baby by cesarean. I’m pregnant again and I’m wondering if I should try for a vaginal delivery this time.”

The answer to your question depends on who you talk to. When it comes to determining whether it’s safe for women to try for a VBAC (vaginal birth after cesarean; pronounced vee-back), the pendulum of opinions—expert or otherwise—continues to swing VBAC and forth. At one time, doctors and midwives were routinely encouraging pregnant women who’d had a C-section in the past to at least try for a vaginal birth (a trial of labor). But then came a study that warned of the risks (of uterine rupture or of the incision coming apart) if VBAC was attempted, leaving many pregnant women—and their practitioners—confused and unsure about what to do when it comes to childbirth after a C-section.

Looking at the statistics, though, your chances of having a successful VBAC are still pretty good. More than 60 percent of women who have had C-sections and who are candidates for a trial of labor are able to go through a normal labor and a vaginal delivery in subsequent deliveries. Even women who have had two cesarean deliveries have a good chance of being able to deliver vaginally, as long as the proper precautions are taken. And the study that caused the VBAC backlash actually showed that uterine rupture is really quite rare, happening only 1 percent of the time. What’s more, that risk is only higher for certain women in certain circumstances, such as those who have a vertical uterine scar instead of a low transverse (95 percent of incisions are low transverse; check the records of your previous cesarean delivery to find out for sure which type of incision you had), or those whose labors are induced by prostaglandins or other hormonal stimulants (these make contractions stronger). Which means that a VBAC is worth a shot if your practitioner and hospital are willing (many hospitals have strict rules about who can or can’t attempt a VBAC and some have stopped allowing VBACs altogether).

If you do decide you’d like to attempt a VBAC, you’ll need to find a practitioner who backs you up on your decision (midwives are more open to VBACs and often more successful at making them work). Most important if you’re pushing for pushing out your baby is to learn everything you can about VBAC, including what your options will be when it comes to pain relief (some physicians limit pain medications during VBAC, some offer epidurals). Keep in mind, too, that if your labor ends up having to be induced, your practitioner will likely veto VBAC.

If, despite all your best efforts, you end up having a repeat C-section, don’t be disappointed. Remember that even the woman who has never had a cesarean before has a nearly 1 in 3 chance of needing one. Don’t feel guilty, either, if you decide ahead of delivery (in consultation with your practitioner) that you’d rather schedule an elective second cesarean delivery than attempt VBAC. About a third of all C-sections are repeats, and many are actually performed at the request of the mother. Again, what’s best for your baby—and
best for you—is what matters.

“My ob is encouraging me to try for a VBAC, but I’m not sure why I should bother.”

While your feelings definitely factor into the decision of whether or not to give VBAC a shot, your ob does have a point—and a point you might want to consider. The risks of a VBAC are very low, and a C-section, after all, is still major surgery. A vaginal birth means a shorter hospital stay, a lower risk of infection, no abdominal surgery, and a faster recovery—all good reasons to favor a VBAC. So it makes sense to weigh the pros and cons of VBAC and a repeat cesarean delivery before you make your decision.

If, after you’ve thought and talked it over, you’re still convinced that VBAC’s not for you, let your ob know your decision and your reasons—and schedule your cesarean delivery without feeling guilty.

“My doctor is going to test me for group B strep infection. What does this mean?”

It means that your doctor’s playing it safe, and when it comes to group B strep, safe is a very good way to play it.

Group B strep (GBS) is a bacterium that can be found in the vaginas of healthy women (and it’s not related to group A strep, which causes the throat infection). In carriers (about 10 to 35 percent of all healthy women are carriers), it causes no problems at all. But in a newborn baby, who can pick it up while passing through the vagina during childbirth, GBS can cause very serious infection (though only 1 in every 200 babies born to GBS-positive mothers will be affected).

If you’re a GBS carrier, you won’t have any symptoms (that’s a plus). But that also means you’re unlikely to know you’re a carrier (that’s a minus—one that could potentially spell trouble for your baby come delivery). Which is why expectant moms are routinely tested for GBS between 35 and 37 weeks (testing done before 35 weeks isn’t accurate in predicting who will be carrying GBS at the time of delivery). Coming soon to a hospital near you (though not yet widely available) is a rapid GBS test that can screen women during labor and provide results within the hour, which might make a test at 35 to 37 weeks unnecessary.

So how’s the test currently done? It’s performed like a Pap smear, using vaginal and rectal swabs. If you test positive (meaning you’re a carrier), you’ll be given IV antibiotics during labor—and this treatment completely eliminates any risk to your baby. (GBS can also show up in your urine during a routine pee-in-cup test at a prenatal checkup. If it does, it’ll be treated right away with oral antibiotics.)

If your practitioner doesn’t offer the GBS test during late pregnancy,
you can request it. Even if you weren’t tested but end up in labor with certain risk factors that point to GBS, your practitioner will just treat you with IV antibiotics to be sure you don’t pass the infection on to your baby. If you’ve previously delivered a baby with GBS, your practitioner may also opt not to test you at 35 to 37 weeks and merely proceed straight to treatment during labor.

Eat Up

Okay, you may be feeling like a cow these days, and that’s all the more reason to keep grazing. Fitting your meals—and baby’s nutrient shipments—into that uterus-cramped stomach of yours is likely getting more and more challenging. Which means that more than ever, the Six-Meal Solution is for you. So graze on, Mom.

Playing it safe through testing—and, if necessary, treatment—means that your baby will be safe from GBS. And that’s a very good thing.

“Is it okay for me to take a bath this far along into my pregnancy?”

Not only is it okay, but a warm bath can provide welcome relief from those late pregnancy aches and pains after a long day (and what day isn’t long when you’re eight months pregnant?). So hop—or rather, gingerly hoist yourself and your mountain of a belly—into the tub and enjoy a good soak.

If you’re worried about bathwater entering your vagina (you may have heard that one through the pregnancy grapevine), don’t be. Unless it’s forced—as with douching or jumping into a pool, two things you shouldn’t be doing anyway these days—water can’t get where it shouldn’t go. And even if a little water does make its way up, the cervical mucous plug that seals the entrance to the uterus effectively protects its precious contents from invading infectious organisms, should there be any floating around in your tub.