birth Archives - Health Beat

Why is the cesarean rate so high, and how can I increase my chance of a natural birth?

Posted on March 3, 2017 by Georges Sylvestre MD

In the field of obstetrics and gynecology, there is no more debatable topic than the increased rate of cesarean (C-section) deliveries. The C-section rate is the percentage of all births that take place surgically, whereby a baby is delivered via an incision on the abdomen. Over the last few decades, this rate has increased tremendously. Up to the 1970’s, the rate of cesarean in the U.S. was less than 5% but in the subsequent few years, it climbed to 33%.

While the cesarean delivery has become a safer operation than it used to be, it is still a major abdominal surgery which should be avoided when a vaginal delivery is an option for both baby and mother. Sadly, rates of complications such as cerebral palsy have not decreased much despite the 600% increase of cesarean deliveries in the last three decades. So why then, has the cesarean rate climbed so much?

There are several factors explaining the increase the cesarean rates and there is no single answer. because so much has changed in the last two of three decades, in terms of medical, social and legal aspects. Let’s look at a few factors:

Breech babies: Few doctors deliver breech babies vaginally because recent studies suggested that C-section births are less risky for them.
Fewer patients attempt a VBAC (vaginal birth after cesarean): Women with a previous C-section are either not interested or not encouraged in having a vaginal birth after cesarean. There are risks involved in attempting a VBAC, but very often, they can be minimized by close fetal surveillance in labor.
Less patience for prolonged labor: Although 24-48 hour labors are often ultimately rewarded by a natural birth, many women prefer to have a cesarean now as opposed to waiting several more hours for a possible natural birth. Sometimes, it’s best to let nature do its work and wait, but physicians and women are often impatient, not tolerant of long (but natural) labor.
C-section delivery has become a much safer operation than it used to be decades ago: Long-term complications or serious short- term complications remain rare. This is mainly attributed to proper use of antibiotics, better and safer anesthesia techniques, and safe blood banking.
Women wait longer to have children: Increasing age is linked to a higher risk of developing complications such as high blood pressure, placenta previa and diabetes, just to name a few. These conditions increase the risk of cesarean.
More multiple births: The rates of twins and triplets have increased by 200-300%. 3-5% of all pregnancies are now twins (or triplets) as opposed to 1% years ago. These high risk pregnancies are associated with a much higher risk of cesarean. The majority of twin pregnancies and nearly all triplets are born via cesarean.
Cesarean delivery on maternal request: Some women feel that women should be entitled to make decisions about their body, and about how they want to deliver and at times, women ask for a cesarean delivery In the absence of a medical indication.,

The WHO (World Health Organization) has been advocating since 1985 to reduce the C-section to10-15 percent since 1985. Here are some tips for women who want to achieve this goal and reduce their chances of having a C-section.

Don’t be tempted to have a “scheduled” induction: while sometimes, labor inductions are medically necessary to prevent an adverse maternal or fetal outcome, many physicians and patients are tempted to “schedule” a delivery at a set time, without a medical reason.
If your baby is breech (baby’s bottom is down instead of the head): attempt an external version. A simple procedure called External Cephalic Version may turn the baby from breech position to head down, simply by turning the baby externally, by an experiences obstetrician.
Be patient. Labors can be long, sometimes very long, so be prepared for it and be patient. Bring a good book, movies, music and try to rest when you can (this is especially possible when you have a well working epidural).
Bring a coach: Having a supportive person during your labor (your spouse, your mother or a trained labor coach, called a Doula) has been shown to decrease the risk of cesarean and also to improve your perception of labor. They will keep you distracted during the often very long process.
Good life habits: women who are physically fit and are within their ideal body weight are less likely to develop diabetes, high blood pressure and excessively large babies during their pregnancy. So if you have healthy life habits, keep up with them! There is no reason to stop exercising during your pregnancy.
Don’t eat excessively: your baby is a magnet for the calories you ingest, so there’s no reason to eat excessively to feed your baby. Don’t believe your mother, aunts or anyone else who force you to eat in order to have a big baby and tell you that “a big baby is healthier”. It simply isn’t true. Six pounds babies are just as healthy as a ten pound ones.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

OB/GYN or Midwife: Which Is Right For You?

Posted on February 9, 2017 by Zakiya Hazel-Jemmott

When you decide to try to conceive, it is important to start looking for a practitioner to care for you during pregnancy and the birth of your baby. Deciding between an OB/GYN doctor and Midwife depends on what kind of experience you want, where you plan to give birth, what your insurance covers and the risk level of your pregnancy. Here are a few factors to consider in making your decision:

If you have a medical condition such as high blood pressure, epilepsy, heart disease, or diabetes, or had certain serious complications in a previous pregnancy, your pregnancy will probably be considered high risk. In this case, you will need to see an obstetrician who will monitor your body as it adapts to pregnancy along with monitoring the development of your baby.
If you’re looking for a practitioner who is more likely to take a holistic approach to your care – and to see birth as a normal process, intervening only when necessary and not routinely – you may prefer a midwife.
If you have no health problems or pregnancy complications and you have your heart set on giving birth in a birth center or at home, you’ll want to find a midwife who practices in these settings. In the event you want the option for an epidural, or are anxious about any possible complications then you’ll want to be in a hospital. For a hospital birth, you can choose an ob-gyn, a family physician, or a certified nurse-midwife as your primary caregiver.

Obstetricians are by far the most chosen option for expecting mothers in the United States, although certified nurse-midwives are becoming more popular. Some women choose practices that have both ob-gyns and midwives. The most important thing to consider when choosing a delivery option is your comfort.

Flushing Hospital Medical Center’s Department of Obstetrics and Gynecology has a full program to provide total health care to women. For more information about the many services offered by the Department of Obstetrics and Gynecology at Flushing Hospital, please call 718-670-8994.

Posted on January 9, 2017 by Zakiya Hazel-Jemmott

January is National Birth Defects Prevention Month. Among the most common birth defects is cleft lip. Cleft lip is a birth defect that occurs when a baby’s lip or mouth does not form properly in the womb. Collectively, these birth defects commonly are called “orofacial clefts”.

The lip forms between the fourth and seventh weeks of pregnancy. A cleft lip develops if the lip tissue does not join completely before birth, resulting in an opening of the upper lip. The opening in the lip varies in size from a small slit or a large opening that goes through the lip into the nose.

The causes of orofacial clefts among most infants are unknown. However, they are thought to be caused by a combination of genetics or other factors, such as things the mother comes in contact with in her environment, or what the mother eats or drinks, or certain medications she uses during pregnancy. Recently the Center for Disease Control reported findings from research studies about risk factors that increase the chance of infant orofacial cleft:

Smoking―Women who smoke during pregnancy are more likely to have a baby with an orofacial cleft than women who do not smoke
Diabetes―Women with diabetes diagnosed before pregnancy have an increased risk of having a child with a cleft lip with or without cleft palate, compared to women who did not have diabetes
Use of certain medicines―Women who used certain medicines to treat epilepsy during the first trimester (the first 3 months) of pregnancy are at greater risk

Orofacial clefts, especially cleft lip with or without cleft palate, can be diagnosed during pregnancy during a routine ultrasound. Services and treatment for children with orofacial clefts can vary depending on:

The severity of the cleft
The child’s age and needs
The presence of associated syndromes
Other birth defects

Surgery to repair a cleft lip usually occurs in the first few months of life and is recommended within the first 12 months of life. Children born with orofacial clefts might need other types of treatments and services, such as special dental or orthodontic care or speech therapy.

If you are an expecting mother in need of a doctor, Flushing Hospital Medical Center’s Department of Obstetrics offers a wide variety of services to expectant mothers. For more information or to schedule an appointment, please call 718-670-8994.