Q. The baby developing within me is in the wrong position–a breech. The doctor tells me I may need a Caesarean. What does this all mean?
A. A Caesarean is considered major surgery, involving a series of separate incisions in the mother. The abdomen’s skin and muscles must be opened. Then an opening must be made in the uterus for the baby to be removed.
A breech-positioned baby is a legitimate reason for performing a Caesarean, if other factors are involved. When the baby that is breech is 8 pounds or larger, when the mother’s pelvic dimensions are considered too small for vaginal passage, or if the baby is positioned with a hyperextended head, then most doctors feel a Caesarean presents less risk than vaginal delivery.
It may be wise for you discuss these factors with your physician. If your doctor has determined that your baby is indeed breech and one of the complicating factors is present, chances are you will have the C-section.
Fortunately, modern medicine and its advances have made the Caesarean a generally safe procedure, and maternal deaths are very rare.
Find out what type of incision will be made. In the past (and sometimes still in the case of breech babies), a vertical incision was often used. This is referred to as the classical operation, allowing a greater opening. This operation is used when fetal size or position is a problem and in some emergency situations.
Nowadays, however, a horizontal incision in the lower uterus often is used. The procedure is called the low transverse cervical (also known as the Pfannenstiel or bikini incision), and it has the lowest incidence of hemorrhage as well as the least chance of rupturing during a later pregnancy.
Don’t be afraid to discuss all of this with your doctor. This is a very special time for you, and your anxiety is understandable. The best medicine for this, however, is knowledge. You have a right and responsibility to know all there is to know about your condition. It’s the best way to make this period of preparation fun and joyous.
Women trying to get pregnant through assisted reproduction methods should stop smoking before treatment. Researchers found a 50 percent reduction in the pregnancy rate among women who smoked during their infertility treatments compared to women who never smoked, according to a study published recently in the medical journal Obstetrics and Gynecology. The study also found that the longer a woman smoked and the more cigarettes she smoked, the fewer the number of eggs and embryos she produced.
Bradley Van Voohis and colleagues at the University of Iowa Hospital and Clinic in Iowa City studied 499 women undergoing assisted reproduction methods. The study found that, on average, for every 10 pack years (number of packs per day times the number of years smoked) 2.5 fewer mature eggs and 2.0 fewer embryos were obtained compared to non-smokers. More important still, current smokers had a 50 percent reduction in successful pregnancy rate compared to non-smokers and past smokers.
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