Vim & Vigor - Winter 2008 - (Page 51)

❋ supporting the patient’s choice Dan Austin, M.D., head of the department of obstetrics/ gynecology at Avista Adventist Hospital in Louisville, says he doesn’t see the trend catching on in Colorado. “I don’t believe that many patients in this area are electing for Caesarean deliveries,” Austin says. “As an obstetrician, I feel that if I consult with the patient on the various pros and cons and that’s still their decision, I’ll support that choice. And I think most other physicians feel the same way. “I think I’d have a greater problem with elective Caesarean birth if 30 or 40 percent of my patients were asking. But that’s not the case. I currently have only one who’s chosen to deliver by C-section, and that’s for personal reasons. “We’re delivering about 2,700 babies a year here at Avista, and our total Caesarean delivery rate—for emergency and elective procedures—is holding steady at only 26 percent. That’s well below the national average.” when is a c-section medically necessary? A C-section is the birth of a baby through an incision in the mother’s abdomen. Most first-time Caesarean deliveries are medically required interventions to protect the baby’s and mother’s health. A C-section birth may become necessary if: • Labor isn’t progressing. A stalled labor is the most common reason for Caesareans. • The baby is in distress. Changes in baby’s heartbeat suggest oxygen supplies are insufficient. • The baby is positioned abnormally. If baby’s body position is breech (buttocks or feet first) or horizontal across the uterus, intervention may be required. The same is true if baby is entering the birth canal face up. • There are multiples. In the case of twins, triplets and other multiples, it’s not uncommon for one baby to be in an abnormal position. • There are placenta or umbilical cord problems. The placenta can detach from the uterus before labor or cover the opening to the cervix. The umbilical cord can precede baby or become compressed. A C-section may be the safest course of action. • The baby is too small or too big. Some babies’ size may make it difficult to achieve a safe vaginal delivery. • The mother has health problems. C-sections may be needed for mothers with a chronic health problem like diabetes, heart disease, lung disease or high blood pressure or for a mother with active genital herpes. ❋ cultural influences Sarah Truitt, M.D., is an OB/GYN with Clinica Family Health Services. Approximately 2,800 prenatal patients are seen annually at the four clinic sites. For 2007, the Caesarean section rate was just 19 percent. “A large percentage of the patients we see share an Hispanic heritage,” Truitt says. “And with that comes a strong cultural hope for a natural birth. That’s certainly true with most of the women I see, with many preferring not to have epidural anesthesia. “Most Clinica families are anticipating having multiple children, or already have small children at home and want the quickest recovery time possible. The fact that a Caesarean birth is major surgery runs counter to those desires. What’s important to us all is the welfare of baby and mom. We want to reduce any risks, and sometimes a Caesarean is the best choice. “I think the higher rates we’re seeing nationally has far less to do with Hollywood than with the shift in demographics. More women are waiting to have babies, and we know women over age 40 are at a higher risk for Caesarean birth in labor. We’re also seeing an increase in obesity and diabetes, both of which increase the risk of intrapartum Caesarean birth. Reproductive technology is also a factor—with multiples, the C-section rate goes up. And we’re seeing more women with prior Caesareans who prefer a repeat surgery to attempting a vaginal birth. “We don’t want to dismiss the fact that women are choosing elective C-sections, though. That’s where the OB provider needs to give as much counseling as possible, particularly about what it can mean for future pregnancies.” ❋ natural childbirth Carla Downing, R.N., ICCE, has been a childbirth educator at Avista Adventist Hospital since it opened 18 years ago. “The fact that more women are choosing C-section deliveries is disappointing to childbirth educators,” Downing says. “We try very hard to help educate moms to help them understand their options and ways to empower themselves for vaginal delivery. Every childbirth preparation class we offer includes information on C-section deliveries, what’s involved and ways to empower themselves. “The people I see, however, are focused on attempting a vaginal delivery, even if they’ve had a prior Caesarean,” Downing says. “That’s one of the nice things about Avista. We’re one of the hospitals that allow a VBAC [vaginal birth after Caesarean]. Many physicians have given up that choice, but here at Avista, we have physicians who will give patients a chance.” vim & vigor • wi nter 2008 51

Table of Contents Feed for the Digital Edition of Vim & Vigor - Winter 2008

Vim & Vigor - Winter 2008 Contents Friendly Faces For Your Health 'Tis the Season to be Safe Eat Your Veggies Joint Effort Fresh Beginnings Decades of Opportunity Keeping Score Your Big Give Roll Up Your Sleeve Tidings of Comfort and Health Blueprint for Safety The Smoke-Free Mom-to-Be Childbirth Trends Moms Choosing Midwives Community Sections Dollars & Sense Ask the Experts

Vim & Vigor - Winter 2008

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