A Woman 's Next Birth After Caesarean

Within Victoria there are multiple models of maternity care available to women. An initial discussion with the woman’s treating GP during the early stages of her pregnancy is critical in her decision-making about which model of care she will choose and this key discussion is essential in allowing a woman to make the first of many informed decisions throughout her pregnancy. According to a survey conducted by Stevens et al. (2010) only 43% of women felt ‘they were not supported to maintain up-to-date knowledge on models of care, and most reported that model of care referrals were influenced by whether women had private health insurance coverage.’ Many elements of these models of care differ: from location of care, degree of caregiver continuity, rates of intervention and maternal and infant health, outcomes access to medical procedure, and philosophical orientation such as natural or medical (Stevens, Thompson, Kruske, Watson, & Miller, 2014). According to the World Health Organization (1985) and Commonwealth of Australia (2008) there is a recognition that ‘85% of pregnant women are capable of giving birth safely with minimal intervention with the remaining 15% at potential risk of medical complications’ (McIntyre & Francis, 2012).

The writer explained there could be no concern for fetal or maternal health during the delivery although some obstetricians tended to induce labor in all diabetic mothers to protect babies and mothers. Moreover, labor progress was supposedly assessed by old-fashioned methods, which resulted in performing unnecessary obstetrical practices. Intervention was imposed in cases of inaccurately labeled slow or abnormal labors and failures to progress. It is common practice that a primary cesarean generally produces subsequent surgical deliveries. The author realized that cesareans were performed because of insufficient data on laboring women’s

Randomization was used to generate what patient went to which group. The way the patients were chosen eliminated bias because “Randomization was performed according to a computer-generated list by means of sequentially numbered, opaque, sealed envelopes which revealed the allocation of the subject to either induction or expectant management”(Nielsen et al. p. 60). This secure randomization added a great strength to the study. The sample size seemed fairly large, 226 patients were split into 116 for elective induction and 110 to expectant management, although the power analysis was disclosed in this study and determined that 600 patients were required. Only 226 patients were used and because it would take 4 years to reach the required amount of patients, the study was discontinued. This was both a strength and weakness because disclosing this information made the study more honest but the quota needed to reach the best answers was not attained. The study for the 226 patients was pretty standard with the 80% power and alpha at 0.05. T-test and chi square tests were used to compare the proportions between the groups of people. The women were chosen based on the inclusion criteria of being 39 weeks gestation or older, maternal age of more than 17, fetal cephalic presentation, singleton gestation, a candidate for vaginal delivery, and a Bishop score of 5 or greater in nulliparous women and 4 or greater for multiparous women. This inclusion criterion was a concern because both nulliparous women and multiparous women were being tested together. This was a weakness because the labor patterns of a nulliparous woman compared to a multiparous woman are very variable and sure to distort study data. It was also disclosed how gestational age was achieved which included the crown rump test measured in 6-12

The author is a nurse in a level two trauma facility in a community of approximately fifty thousand people in Oregon. The community is a college-town surrounded by a large agricultural area. There is a minimal ethnic diversity within the community. The diversity present occurs mainly from internationally students and faculty from the college. There is a growing population of women who desire low interventional births in the community. The author has worked on the labor and delivery unit of the hospital for the last 14 years. The hospital is the only one in the area to offer trial of labor services to women who have previously undergone a cesarean section. The unit on average experiences around 1000 deliveries annually.

The intent of this paper is to examine effective solutions for reducing cesarean deliveries. Cesarean deliveries involve more risk to both the mother and baby than vaginal births do. Cesarean deliveries have a higher potential of complications than vaginal births. Cesarean deliveries cost more, require longer hospital stays, and require more resources—both human and systemic—than vaginal births.

A concern that many women have who have undergone cesarean birth, is whether or not they can have a vaginal birth after. The answer is yes; they can have a vaginal birth, but only if the incision made was a horizontal one. The benefits are the woman ass’d with fewer blood transfusions, fewer post-partum infections and shorter hospital stays (Rose, 1). On the other hand there are many risks: the uterine may rupture, it could result in maternal and

In depth discussion of planned and emergency C/S deliveries were also discussed. Planned C/S births were defined as “breech presentation, multiple pregnancy, preterm birth, small for gestational age, placenta praevia, morbidly adherent placenta, cephalopelvic disproportion in labor, mother-to-child transmission of maternal infection, Hepatitis B and C viruses, Herpes, and maternal request for C/S birth was outlined” (National Guideline Clearinghouse, 2011). An in-depth outline of anesthesia and surgical techniques followed. It seems that this source addressed nearly every type of C/S birth technique, including “method of placental removal, exteriorization of the uterus, closure of the uterus, peritoneum, abdominal wall, and subcutaneous tissue, use of superficial wound drains, closure of skin, and even timing of antibiotic administration and thromboprophylaxis for C/S births. Care of the woman after C/S surgery, routine monitoring, pain management, eating and drinking after surgery, and removing the urinary catheter after C/S surgeries was also discussed(National Guideline Clearinghouse, 2011)”. There is even a benefits/harms section that looks at potential risks and successes of C/S deliveries. The National Guidelines Clearinghouse

Cesarean births have been on the rise over the last decade and are associated more with failed inductions than with medical necessity. C-sections are associated with more short and long term complications for mother and baby. By promoting a pregnant woman to opt out of inductions before 40-42 weeks and educating about vaginal birth after cesarean section, the United States can drop the number of cesarean sections performed.

According to “Human Sexuality: Diversity in Contemporary America,” women and couples planning the birth of a child have decisions to make in variety of areas: place of birth, birth attendant(s), medication, preparedness classes, circumcision, breast feeding, etc. The “childbirth market” has responded to consumer concerns, so its’ important for prospective consumers to fully understand their options. With that being said, a woman has the choice to birth her child either at a hospital or at home. There are several differences when it comes to hospital births and non-hospital births.

There has been a long debate over which birthing method women should use today: natural versus medicalized. The World Health Organization defines natural birth as a vaginal birth without the use of any.. and medicalized birth as being .. However, medicalized births are becoming increasingly popular in the United States. The use of technology and medical interventions in the birthing process has increased despite the unchanged basic physiology of childbirth. One of the most common medical interventions in the birthing process is having a cesarean delivery. Despite the known risks of having a cesarean section performed, the rates of this procedure have increased much higher than the acceptable rate of 10-15% as recommended by the World Health Organization. This is due to the reason that cesarean sections are now being performed as a matter of convenience of the physician or at the request of the patient more often than being performed as a life-saving intervention. Thus making surgical and medicalized interventions a part of a common routine in the childbirth experience.

Within the March problem of OBG Management, Dr. William Camann, director of obstetric anesthesiology at Brigham and Women's Medical center in Boston and a co-employee professor of anesthesia at Harvard Medical College, co-wrote an editorial, "Mom-, Baby-, and Family-Centered Cesarean Delivery: IT'S POSSIBLE," where he explained a few of the choices which may have become available within the last year or two.

"Women who undergo vaginal births avoid major surgery and its associated risks, such as severe bleeding, scarring, infections, reactions to anesthesia and more longer pain." (Nierenberg) For the mother, "the experience of actively delivering a baby is exciting and empowering. (Why Choose Vaginal Birth). "Vaginal birth is the essence of femininity to most women. It biologically and physically links all women. It is also an expression of a woman's sexuality." (Why Choose Vaginal Birth) Another reason that women would rather have a vaginal birth is because, "from a psychological standpoint, women who go through with a vaginsl delivery are said to have a more positive birthing experience." (Vaginal Delivery vs C-Section) There are several positives for the baby in a vaginal delivery. One positive is, "during a vaginal delivery, muscles involved in the process are more likely to squeeze out fluid found in a newborns lungs." (Nierenberg) "Babies born via vaginal delivery tend to

Birth by cesarean gives several challenges for a baby. If we Compare vaginally born babies with babies born by cesarean, the latter are at risk for health complications they are less likely to face with a normal birth. Breathing problems are more likely if baby is premature and was born by caesarean. They may also happen if baby was born by a caesarean before your labour started, particularly before 39 weeks of pregnancy. With a scheduled cesarean, babies are more likely to be born preterm, before the lungs have fully developed. Respiratory complications can be serious enough to get admitted to nursery.

In this article, the author brought up a good point about choosing vaginal birth vs. scheduled C-section. In today’s day, there are still mixed review on the purpose of having a scheduled C-section. Many mothers still prefers to opt for vaginal birth however, there are also some who

Vaginal birth after caesarean (VBAC) is the name used for identifying the method of giving birth vaginally after previously delivering at least one baby through a caesarean section (CS). A trial of labour (TOL) is the term used to describe the process of attempting a VBAC. An elected repeat caesarean (ERC) is the other option for women who have had a caesarean in the past. The rates of women choosing to deliver by means of an ERC has been increasing in many countries, this is typically due to the common assumption that there are too many risks for the baby and mother (Knight, Gurol-Urganci, Van Der Meulen, Mahmood, Richmond, Dougall, & Cromwell, 2013). The success rate of VBAC lies in the range of 56 - 80%, a reasonably high success rate, however, the repeat caesarean birth rate has increased to 83% in Australia (Knight et al., 2013). It is essential to inform women of the contraindications, success criteria, risks, benefits, information on uterine rupture and the role of the midwife in relation to considering attempting a VBAC (Hayman, 2014). This information forms the basis of an antenatal class (Appendix 1) that provides the necessary information to women who are considering attempting a VBAC and can therefore enable them to make their own decision regarding the mode of birth.