Tuesday, September 23, 2008

Knowledge can help beat the odds of a Caesarean

Women can reduce their chances of having a Caesarean, area maternity care providers say
BY ANNIE ADDINGTON - aaddington@ledger-enquirer.com --


Certified labor doula and childbirth educator Val Staples knows firsthand the value of a Caesarean.

Her now 16-year-old son, Joshua, was born prematurely and presented in breech (or bottom-down) position, and Staples' doctor decided that a Caesarean was in order. Although Staples, who lives in Opelika, Ala., regrets not going into that first pregnancy more fully informed about her options, she believes her doctor made the safest choice.

But she also believes deeply in the value of a natural vaginal birth when conditions permit it. That's why, after plenty of research and preparation, Staples went on to have a successful natural VBAC (vaginal birth after Caesarean) a year later, when her second son was born in 1993 -- and then four more natural VBACs after that.

Without that first Caesarean, it is possible Staples might never have had children to begin with. Without the opportunity for VBAC, Staples likely wouldn't be matriarch in a family of eight. The American College of Obstetricians and Gynecologists says that women who have more than one or two children via Caesarean face increasing risks for serious complications.

Staples, who now serves as director of doula programs for the Childbirth and Postpartum Professional Association in Atlanta, is grateful that her childbearing years hit before the era of concerns about safety and professional liability made it nearly impossible to get a VBAC in many communities. But she is also a realist, and she says that her mission now as a doula -- a nonmedical assistant in childbirth -- and as a childbirth educator, is to help women prevent that first Caesarean if possible.

Staples said she believes it is possible for women to work proactively to defy the national statistics -- which suggest that American women now have a 31 percent chance of having a Caesarean. A hearty dose of research, preparation and healthy living during pregnancy can significantly decrease your chances of needing a Caesarean, Staples said.

"My big thing now is getting those first-time moms and preventing those first Caesareans," said Staples. "If they start out with an induction when they're not necessarily ready to be in labor, they're increasing their chances of a C-section, and next time around they're probably going to have to have a Caesarean again."

Avoiding interventions

Staples said every intervention -- whether it be rupturing membranes, inducing or accelerating labor with Pitocin, or giving an epidural before a woman is in active labor -- increases the odds of complicating the labor, throwing the body out of synch with its natural rhythm and potentially making a Caesarean necessary.

Melissa Terry Flynn, a certified nurse-midwife with Obstetric and Gynecologic Associates of Columbus, agrees that women have power to reduce the likelihood of needing a Caesarean.

"Choosing not to have interventions decreases your risk of complications and C-sections," she said. "Choosing to allow labor to start on its own, choosing to allow labor to progress on its own without intervention -- without any kind of medication or any kind of anesthesia would reduce your chances."

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