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Ask the Expert: Reducing elective C-sections before 39 weeks of pregnancy

During the past several years, a number of leading health care organizations have spoken out against performing elective cesarean sections before the 39th week of pregnancy. As a result, many hospitals, including those affiliated with Baptist Memorial Health Care, have made significant efforts to reduce or eliminate the practice. In this Ask the Expert column Dr. Pamela Lacy, an obstetrician and gynecologist who practices at Baptist Golden Triangle, discusses the importance of waiting until at least 39 weeks of pregnancy before performing non-emergency C-sections.

What are cesarean sections?

What are cesarean sections?

A cesarean section is a surgical procedure that involves removal of the fetus through incisions in the abdomen and uterus. The optimal time to perform a cesarean is at 39 completed weeks of gestation. The fetus is completely developed at this time.

When and why must cesarean sections be performed?

When and why must cesarean sections be performed?

A cesarean section must be performed when a fetus is not in the head down position, which is optimal for going through the birth canal. A cesarean is required when placental abnormalities, such as placenta previa, occur. In this situation, the placenta obstructs the opening of the uterus. Cesareans may also be performed if the cervix does not completely dilate or if fetal distress occurs.

How often are cesarean sections performed?

How often are cesarean sections performed?

Cesarean sections are one of the most common surgical procedures performed in the United States. Unfortunately, the national average has steadily increased over time. It is currently 32 percent, meaning that one out of three mothers will undergo a cesarean. The current school of thought is to evaluate women who have had a cesarean in the past to see if they are potential candidates for a vaginal delivery with future pregnancies.

What are the risks associated with cesarean sections?

What are the risks associated with cesarean sections?

The risks associated with cesareans are bleeding, infection, and injury to the bowel and the bladder. With excessive bleeding, a blood transfusion may be warranted, which comes with its own set of risk factors.

What are the risks with multiple cesarean sections?

What are the risks with multiple cesarean sections?

A major risk factor is the need for a repeat cesarean with future pregnancies if extensive uterine lacerations occur. Multiple cesarean sections can lead to placental abnormalities with implantation. The placenta can embed within the uterine scar, penetrate the uterine wall, and even invade into the bladder. In these situations, a hysterectomy may be required to control bleeding. Adhesions can form involving the bladder, bowel, and uterus, leading to increased risk of injury to the mother and the fetus.

How can cesarean sections be prevented?

How can cesarean sections be prevented?

Cesarean sections can be reduced by being patient with the labor process. New research shows that if obstetricians use six centimeters rather than four centimeters as active labor, more women will have a successful vaginal delivery. Cesareans should be avoided if possible, because they can increase the morbidity and mortality of the mother and the fetus. If the patient plans on having three or more children, these risks increase substantially with each repeat cesarean.

Anything else?

Anything else?

Sometimes it is necessary to perform a cesarean to ensure the health and well-being of the mother, fetus, or both. It is not a procedure that should be taken lightly. Every laboring patient deserves the right to have a fair trial of labor. Each patient needs to be evaluated on an individual basis, because not everyone will follow the standard labor curve. There are always outliers who go on to have a successful vaginal delivery.
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