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Pregnancy Week by Week : Week 37 (part 2) - Vaginal Birth after Cesarean

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Vaginal Birth after Cesarean (VBAC)

Should you attempt a vaginal delivery after having had a Cesarean delivery? Medically speaking, the method of delivery isn’t as important as the well-being of you and your baby. Before any final decision is made, weigh the risks and benefits. In some cases, there may not be any choice in the matter. In other cases, you and your doctor may decide to let you labor for a while to see if you can deliver vaginally.

Some women like having a repeat Cesarean delivery because they don’t want to go through labor only to end up with a Cesarean delivery. You may need another Cesarean if you have had problems with this pregnancy. Discuss it with your doctor if you have questions.

If you are small and the baby is large, you may need another Cesarean. Multiple fetuses may make vaginal delivery difficult or impossible without danger to the babies.

If a woman has a Cesarean delivery, she is at increased risk for post-partum depression.

Inducing labor with a VBAC may be necessary; however, there’s an increased risk of the uterine scar from an earlier Cesarean stretching and pulling apart with induction. This is especially true if hormones are used to ripen the cervix and/or induce labor. It is believed that contractions may be too strong for a uterus scarred by previous surgery. A repeat Cesarean may be advised to avoid rupturing the uterus.

Risk also increases for a woman who gets pregnant within 9 months of having a previous Cesarean. In this case, the uterus is more likely to rupture during a vaginal delivery. Researchers believe this might occur because it can take from 6 to 9 months for the uterine scar to heal (this is the scar on the uterus—not your abdomen). Until enough healing time has passed, the uterus may not be strong enough to stand up to the stress of a vaginal delivery. VBACs are safest when at least 18 months have passed between the previous Cesarean and the attempted vaginal delivery.

Advantages of VBAC include a decreased risk of problems associated with surgery, which a Cesarean is. Recovery after a vaginal delivery is shorter. You can be up and about in the hospital and at home in a much shorter amount of time.

If you want to try VBAC, discuss it with your doctor in advance so plans can be made. Not all hospitals are equipped for VBAC. During labor, you will probably be monitored more closely. You may be attached to I.V.s, in case a Cesarean delivery becomes necessary.

Consider the benefits and risks in deciding whether to attempt a vaginal delivery after a previous Cesarean delivery. Discuss them at length with your doctor and your partner before making a final decision. Don’t be afraid to ask your doctor his or her opinion of your chances for a successful vaginal delivery. He or she knows your health and pregnancy history.

Tip for Week 37

Be prepared for delivery with bags packed, insurance papers filled out and available, and other important details taken care of.

6. Your Nutrition

You and your partner have been invited to a big party. You’ve been careful about your nutrition, and your pregnancy is almost over. Should you let yourself go, and eat and drink whatever you want? Probably not. Maintain your good eating habits. You can party healthfully. Before you go, eat or drink something to take the edge off your appetite. It may be easier to avoid high-fat, high-calorie foods if you’re not ravenous.

At the party, eat food when it’s fresh or hot—at the beginning of the party. As the party goes on, the food may not be chilled or heated enough to prevent bacteria from growing. So eat early or when dishes are refilled.

Avoid alcohol. Drink fruit juice “spiked” with ginger ale or lemon-lime soda. If it’s the holiday season and they’re serving eggnog, have a glass if it’s pasteurized and alcohol-free.

Raw fruits and vegetables can be satisfying. Avoid raw seafood, raw meat and soft cheeses, such as Brie, Camembert and feta. They may contain listeriosis.

Stay away from the refreshment table if you can’t resist the goodies. It may feel better to sit down (away from food), relax and talk with friends.

Will You Have an Enema?

Will you be required to have an enema when you arrive at labor and delivery? An enema is a procedure in which fluid is injected into the rectum to clear out the bowel. An enema before labor can make the birth of your baby more pleasant for you. When the baby’s head comes out through the birth canal, anything in the rectum also comes out. An enema decreases the amount of contamination from feces during labor and at the time of delivery, which may also help prevent infection.

Dad Tip

You may not understand how nervous your partner may be about getting in touch with you when she needs you. Be sure to let her know how she can reach you at work or when you’re out. Keep your cell phone or a beeper with you all the time. This can comfort her and provide her with peace of mind.

Most hospitals offer an enema at the beginning of labor, but it’s not always mandatory. There are certain advantages to having one early in labor. You may not want to have a bowel movement soon after your baby’s birth because of discomfort. Having an enema before labor can prevent this discomfort.

Ask your doctor if an enema is routine or considered helpful. Tell him or her you’d like to know about the benefits of an enema and the reasons for giving one. It isn’t required by all doctors or all hospitals.

What Is Back Labor?

Some women experience back labor. Back labor refers to a baby coming through the birth canal looking straight up. With this type of labor, you will probably experience lower-back pain. Back labor can also last longer.

The mechanics of labor work better if baby is looking down at the ground so it can extend its head as it comes out through the birth canal. If the baby can’t extend its head, its chin points toward its chest, which may cause pain in your lower back during labor. Your doctor may need to rotate the baby so it comes out looking down at the ground rather than up at the sky.

Will Your Doctor Use a Vacuum Extractor or Forceps?

The goal with every birth is to deliver a baby as safely as possible. Sometimes baby needs a little help. Your doctor may use a vacuum extractor or forceps to help safely deliver baby. Vacuum and forceps delivery methods each have about the same risks. Use of either is associated with a more frequent need for mechanical ventilation in infants and with more 3rd- and 4th-degree perineal tears.

Vacuum extractors are used more today than forceps. There are several types of vacuum extractors. Some have a plastic cup that fits on baby’s head by suction. Another type has a metal cup that fits on baby’s head. The doctor attaches the cup to baby’s head and gently pulls on it to deliver baby’s head and body.

Forceps is a metal instrument used to deliver babies; it looks like two large metal hands. Use of forceps has decreased in recent years. If a lot of traction with forceps is needed to deliver baby, a Cesarean may be a better choice. Cesarean deliveries are also used more often to deliver a baby that is high up in the pelvis.

If the possible use of a vacuum extractor or forceps causes you concern, discuss it with your healthcare provider. It’s important to discuss issues that may come up during labor and delivery so you can communicate your concerns.

7. Exercise for Week 37

 

Sit on a chair or on the floor in a crossed-leg position. Inhale, and slowly tilt your head to the right until you feel a stretch in your neck. Breathe deeply 3 times while holding the stretch. Slowly bring your head to the center, then tilt your head to the left. Hold while you breathe deeply 3 times. Do 4 times on each side. Helps stretch the neck, and relieves neck and shoulder tension.

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