Posts Tagged ‘cesarean’

When your baby is overdue

Monday, September 30th, 2013

bellyThe average healthy pregnancy is around 40 weeks. Some babies come earlier and others run later. A pregnancy that lasts longer than 42 weeks is called a post-term pregnancy.

Dr. Siobhan Dolan discusses overdue pregnancies in the book Healthy Mom Healthy Baby. Here is an excerpt from the book.

“Although many post-term babies are healthy, some risks do start to increase after 41 to 42 weeks. An overdue pregnancy takes a toll on the placenta, amniotic fluid, and umbilical cord. As the baby grows larger, the chances of stillbirth and delivery injuries go up, and there is a greater likelihood that the baby will experience meconium aspiration (inhaling stool from the amniotic fluid into the lungs) or a condition called dysmaturity syndrome (in which the baby is no longer getting enough nourishment because the placenta is aging and becoming calcified).

“When a baby is overdue, the provider may do some tests to check on the baby’s health. They include:
Ultrasound exam 
Kick count, which is a count of how many times your baby moves or kicks you during a certain period of time
Nonstress test, in which a fetal monitor measures your baby’s heart rate for a certain amount of time
Biophysical profile, which uses a fetal monitor and an ultrasound to score a baby on each of five factors (nonstress test, body movements, breathing movements, muscle tone, and the amount of amniotic fluid)
Contraction stress test, which compares your baby’s heart rate at rest with the heart rate during contractions induced by a shot of oxytocin or nipple stimulation

“If these tests suggest that your baby is in good condition, you can continue to wait for labor to begin naturally. If they raise concerns, your provider may wish to induce labor or perform a c-section. Providers rarely allow a pregnancy to go beyond 42 weeks.”

Study shows we can reduce unnecessary early deliveries

Tuesday, April 9th, 2013

A study published today in Obstetrics & Gynecology shows that hospital-based quality improvement programs across many states can be remarkably effective at reducing early elective deliveries of babies.

The rate of elective early term deliveries (i.e., inductions of labor and Cesarean sections without a medical reason) in a group of 25 participating hospitals fell significantly from 27.8 percent to 4.8 percent during the one-year project period, an 83 percent decline.

The March of Dimes, which partly funded the study, calls the findings good news, because babies delivered before full-term are at increased risk of serious health problems and death in their first year of life.

“This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life,” says Bryan T. Oshiro, MD, of Loma Linda University School of Medicine and lead author of the study.

“Reducing unnecessary early deliveries to less than five percent in these hospitals means that more babies stayed in the womb longer, which is so important for their growth and development,” says Edward R.B. McCabe, MD, medical director of the March of Dimes. “This project saw a decrease in the proportion of babies born at 37 and 38 weeks and a corresponding increase in the 39-41 week range during the one-year period studied. Additional studies, perhaps over a longer period of time, could clarify whether such quality improvement programs can also bring down a hospital’s overall preterm birth rate.”

This was the first project of a collaborative with perinatal quality improvement advocates from state health departments, academic health centers, public and private hospitals, and March of Dimes chapters from the five most populous states in the country: California, Florida, Illinois, New York, and Texas. These five states account for an estimated 38 percent of all births in the United States.

The March of Dimes urges hospitals, health care providers, and patients to follow the American College of Obstetricians and Gynecologists guidelines that if a pregnancy is healthy, to wait for labor to begin on its own. The final weeks of pregnancy are crucial to a baby’s health because many vital organs, including the brain and lungs, are still developing.

“A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks,” by Dr. Oshiro and others, appears in the April 8 online edition of Obstetrics & Gynecology, Vol. 121, No. 5, May 2013.

What is the breech position?

Friday, April 5th, 2013

Dr. Siobhan Dolan discusses the breech position in the new March of Dimes book, healthy mom, healthy baby.

“Babies typically move into a head-down position during the last month or so of pregnancy. But some don’t, meaning that when labor starts, they are positioned to be born feet-first or buttocks-first. This is called the breech position. Having a breech baby is most likely to happen when a woman goes into labor early, has had previous pregnancies, is pregnant with more than one baby, has a condition in which there is too little fluid in the amniotic sac, or has problems or abnormalities with the uterus or placenta. Sometimes it happens for no identifiable reason.

“If your baby is breech, your provider may recommend a procedure called an external cephalic version. In this procedure, a provider places his or her hands on your belly and tries to move the baby into a head-down position from the outside of your body. This can be uncomfortable, and it may not work. Sometimes a “version,” as it is often called, is attempted more than once. Delivering a breech baby vaginally is risky, especially for mothers having their first delivery, so if your baby can’t be moved out of the breech position, your provider will likely recommend a c-section.”

Learn more about healthy mom, healthy baby, read excerpts from the book, even order a copy at this link. 

Preeclampsia is not a thing of the past

Monday, January 28th, 2013

downton-abbey1Did you watch Downton Abbey? What a shocker! But did you know that losing a mother and/or baby to eclampsia resulting from preeclampsia still happens today?

Preeclampsia is a condition that happens only during pregnancy (after the 20th week) or right after pregnancy. It’s when a pregnant woman has both high blood pressure and protein in her urine. We don’t know what causes it and we don’t know how to prevent it.

Most women with preeclampsia have healthy babies, but it can cause severe problems for moms. Without treatment, preeclampsia can cause kidney, liver and brain damage. It also may affect how the blood clots and cause serious bleeding problems. In rare cases, preeclampsia can become a life-threatening condition called eclampsia that includes seizures following preeclampsia. Eclampsia sometimes can lead to coma and, in Lady Sybil’s case, death.

It has been nearly 100 years since the time of the story portrayed on Downton Abbey, yet to this day there still is no cure for preeclampsia except immediate delivery of the baby, often via cesarean section. Preeclampsia can turn into full eclampsia fairly quickly and it’s important that medical professionals keep an eye out for signs.

Signs and symptoms of preeclampsia include:
  High blood pressure  
  Protein in the urine
  Severe headaches  
  Vision problems, like blurriness, flashing lights, or being sensitive to light
  Pain in the upper right belly area
  Nausea or vomiting  
  Dizziness
  Sudden weight gain (2 to 5 pounds in a week)
  Swelling in the legs, hands, and face 

It’s true that many of these signs and symptoms are normal discomforts of pregnancy. That’s one of the reasons why it’s so important to receive regular prenatal care. If you’re pregnant and have severe headaches, blurred vision or severe upper belly pain, call your health care provider right away.

You can read one woman’s personal story here, and for more information about preeclampsia, go to this link.

Fetal scalp pH testing

Wednesday, January 9th, 2013

Fetal scalp blood sampling is a quick test your health care provider can use to check if your baby is getting enough oxygen during labor.

Sometimes fetal heart monitoring doesn’t provide enough information about how the baby is doing with the stress of labor. In these cases, testing the scalp pH can help the health care provider decide whether the baby is getting enough oxygen during labor. This helps the provider decide if the baby is healthy enough to continue labor on its own, or if a faster delivery with forceps or a cesarean section might be a better route to take.

During labor, a woman’s cervix, the opening of the uterus, thins and opens to let her baby pass through the vagina. In order to have fetal scalp blood sampling, the cervix must be dilated enough that the provider can reach the baby’s head.

The test may remind you of a pelvic exam. It takes about 5 minutes. The woman lies on her back with her feet in stirrups. The provider places a plastic cone in the vagina that fits up against the baby’s head. The provider pricks the baby’s scalp and takes a small amount of blood. The blood is tested, and results are ready in just a few minutes.

If mom has an infection, like HIV or hepatitis C, her provider may not recommend fetal blood sampling. This is because she can pass these infections to her baby through the spot where his scalp is pricked.

Lose the weight before pregnancy

Wednesday, January 2nd, 2013

Advertisements abound these days for weight loss programs and quick fix diets. Did you eat all your favorite traditional treats over the holidays and have a cup or two of cheer? I certainly did and am now feeling like it’s time to behave – time to swap the cookies for carrots, the fruitcake for fruit.

For those of you thinking about pregnancy, it’s especially important to get your weight under control before you conceive. To know if you’re overweight or obese, find out your body mass index (BMI) before you get pregnant.  BMI is a calculation based on your weight and height.

If you’re overweight, your BMI is 25.0 to 29.9 before pregnancy. Two in 3 women (66 percent) of reproductive age (15 to 44 years) in the United States is overweight.  If you’re obese, your BMI is 30.0 or higher before pregnancy. About 1 in 4 women (25 percent) is obese.

If you’re overweight or obese, you’re more likely than pregnant women at a healthy weight to have certain medical problems during pregnancy. The more overweight you are, the higher are the risks for problems. These problems include:
   • Infertility (not being able to get pregnant)
   • miscarriage (when a baby dies in the womb before 20 weeks of pregnancy)
   • stillbirth (when a baby dies in the womb before birth but after 20 weeks of pregnancy) 
   • high blood pressure and preeclampsia (a form of high blood pressure that only pregnant women get). It can cause serious problems for mom and baby.
   • gestational diabetes 
   • complications during labor and birth, including having a really big baby (called large-for-gestational-age) or needing a cesarean section (c-section).

Some of these problems, like preeclampsia, can increase your chances of preterm birth, birth before 37 completed weeks of pregnancy. This is too soon and can cause serious health problems for your baby. (We’ll talk about how mom’s weight issues can affect her baby’s health in tomorrow’s post.)

For those women who are severely overweight, some are turning to surgery. New studies suggest that weight-loss surgery may help protect obese women and their babies from gestational diabetes, high blood pressure, overly large babies and cesarean delivery during pregnancy.

So think about staying healthy and shedding those unwanted pounds before you get pregnant. Talk with your health care provider, find a plan that’s good for you and stick to it. You’ll have a healthier and more comfortable pregnancy when the time comes.

Helping moms and babies across the country

Wednesday, December 5th, 2012

Working with our partners, the March of Dimes strives to develop and implement local programs that will ultimately improve the health of babies. Through our network of chapters and volunteers, these programs reach over a million people across the country and Puerto Rico each year. We provide information and services designed to prevent premature birth and birth defects and to promote healthy pregnancies.

Community grants are awarded annually to fund the best programs. Local programs like Centering Pregnancy®, group prenatal care, are focused on improving the availability and quality of health care. We also support services that help promote the health and well-being of women and couples before pregnancy to increase their chances of having a healthy baby. Other programs educate doctors and nurses about reducing the rates of elective labor inductions and c-sections before the 39th week of pregnancy.

Through NICU Family Support®, we provide information and comfort to families coping with the experience of having a baby in a newborn intensive care unit (NICU). NICU Family Support complements and enhances family-centered care practices in partner hospitals, addresses the needs of families and provides professional development to NICU staff.

Contact your local chapter of the March of Dimes to find out how we’re helping moms in your community.

Pregnant with multiples

Thursday, November 8th, 2012

tripletsBeing pregnant with one baby has its ups and downs, but twins, triplets and up can be a big challenge.

Today, more than 3 percent of babies in this country are born in sets of two, three or more; about 95 percent of these multiple births are twins. The high number of multiple pregnancies is a concern because women who are expecting more than one baby are at increased risk of certain pregnancy complications, including premature birth (before 37 completed weeks of pregnancy).

Women who are expecting multiples generally need to visit their health care providers more frequently than women expecting one baby. These extra visits can help prevent, detect and treat the complications that develop more often in a multiple pregnancy. Health care providers may recommend twice-monthly visits during the second trimester and weekly (or more frequent) visits during the third trimester.

Starting around the 20th week of pregnancy, a health care provider monitors the pregnant woman carefully for signs of preterm labor. He/she may do an internal exam or recommend a vaginal ultrasound to see if the woman’s cervix is shortening (a possible sign that labor may begin soon).

Even if a woman pregnant with multiples has no signs of preterm labor, her provider may recommend cutting back on activities sometime between the 20th and 24th weeks of pregnancy. She may be advised to reduce her activities even sooner and to rest several times a day if she is expecting more than two babies.

As a multiple gestation progresses, the health care provider regularly checks the pregnant woman’s blood pressure for preeclampsia. He/she also may recommend regular ultrasounds starting around 20 weeks of pregnancy to check that all babies are growing at about the same rate.

During the third trimester, the provider may recommend tests of fetal well-being. These include:
    -  The non-stress test, which measures fetal heart rate when the baby is moving
    -  The biophysical profile, which combines the non-stress test with an ultrasound

The chance of a cesarean birth is higher in twin than in singleton births. However, a pregnant woman has a good chance of having a normal vaginal delivery if both babies are in a head-down position and there are no other complications. When a woman is carrying three or more babies, a cesarean birth usually is recommended because it is safer for the babies.

To learn more about multiples, read this article.

Breech birth

Friday, October 12th, 2012

Most babies prepare to enter this world head first. A small percentage of babies, however, don’t make that final turn and end up offering themselves feet or fanny first. This is called breech presentation.

We’re not sure why these babies don’t turn, but it does appear more common under these circumstances:
  • When there has been a previous breech presentation
  • In pregnancies of multiples (twins, triplets…)
  • When the amniotic fluid is abnormally low or high
  • If a woman has placenta previa
  • If her uterus is abnormally shaped or if she has fibroids
  • If there is a history of premature delivery

If a breech presentation is suspected, an ultrasound will confirm it. Most breech babies are born healthy, but there may be a slight increase in the risk of the baby having a birth defect and closer examination may be offered.

When a baby is in a breech position, health care providers will try to encourage it to turn into the head down position some time between 32 and 37 weeks. There are different ways to attempt this and it’s important for a woman to discuss the options with her provider to determine which is safest for her pregnancy. These are a few of the options (no guarantees that any of them will work, though):
  • External version – This may require medication to relax mom’s uterus. Essentially, this involves the provider pushing on the lower abdomen to rotate the baby. It is monitored by ultrasound and the fetal heart rate is checked regularly. This is not an option for women carrying multiples, in cases of low amniotic fluid, or when a woman has had previous c-sections.
  • Chiropractic care – The Webster technique is used to reduce stress on the woman’s pelvis, optimize its mobility, decrease the tension on the uterus and relax supporting ligaments. This regional relaxation makes it easier for the baby to turn on his own.
  • Breech tilt – Mom lies flat on her back and then raises her hips about 12 inches off the floor and supports them with pillows. She stays in this position for about ten minutes, three times per day. This can be alternated with Mom resting her head on a pillow and raising her hips up, resting on her knees. These positional shifts let gravity help move her baby. 
  • Hypnosis – A good hypnotherapist may be able to place a woman in a state of deep relaxation which might make it easier for her baby to turn.
  • Moxibustion – Used to stimulate the baby’s movement, this is an ancient Chinese technique that involves burning herbs and focusing on acupressure points, typically performed by an accupuncturist.

When babies still don’t turn, most will be delivered by cesarean section, though not before 39 weeks if all is going smoothly. While most providers will not consider it, there are occasional circumstances when a vaginal delivery might be possible in a breech position. In such cases, a woman wants to be sure that her provider is well experienced in these types of deliveries. She should be mindful that cesarean may still be a necessary final outcome.

Watching the new PBS series “Call the Midwife” last week inspired this post. Did you see it? What did you think?

Worth the Wait Campaign

Friday, February 10th, 2012

The March of Dimes campaign to reduce medically unnecessary early deliveries is being elevated to the forefront of the nation’s maternal and child health agenda.
 
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius has announced the launch of Strong Start, a multi-faceted perinatal health campaign. This public-private partnership includes expansion of “Healthy Babies are Worth the Wait™” — the March of Dimes public awareness campaign to let women and health care providers know that if a pregnancy is healthy, it is best to wait for labor to begin on its own, rather than scheduling an induction of labor or a cesarean section.

“Premature birth is a serious health problem, and the public and private collaboration that will be generated by the Strong Start program is the single most important step forward to date in our nation’s prematurity prevention efforts,” said Dr. Jennifer L. Howse, March of Dimes president. “Working together to eliminate medically unnecessary early deliveries will reduce the emotional and financial burden of prematurity for thousands of families.”

Nearly a half million babies are born too soon each year in the United States. Preterm birth is the leading cause of newborn death, and babies who survive an early birth often have breathing problems, cerebral palsy, intellectual disabilities and other health challenges. Recent research has shown that important development of an infant’s brain and lungs occur during the last few weeks of pregnancy. Babies born just a few weeks early have higher rates of hospitalization and illness compared to full-term infants.
 
Through its “Healthy Babies are Worth the Wait” public awareness campaign, the March of Dimes educates women that if their pregnancy is healthy, it is best to wait for labor to begin on its own. The March of Dimes also is working with hospitals to implement best practices that discourage early elective deliveries before at least 39 completed weeks of gestation.

The March of Dimes awareness campaign includes television, online and print public service advertising, as well as patient education materials. Through Strong Start, these will be co-branded with the U.S. Department of Health and Human Services and the American Congress of Obstetricians and Gynecologists and distributed more widely. (More information for women is available online at marchofdimes.com/39weeks.)

In addition, HHS has pledged to encourage participation by the thousands of hospitals across the country that have joined the HHS Partnership for Patients – a national, voluntary effort to improve health care safety and reduce avoidable harm.