Mamas on Bedrest: Should I have tried vaginal birth?

February 15th, 2012

My daughter’s birth was traumatic. Born via an “emergent” cesarean section, she was in respiratory distress when she was delivered and I began to bleed profusely.

We had planned to deliver my daughter via cesarean section at 39 weeks. My history of uterine fibroids and subsequent myomectomy made it risky for me to deliver vaginally according to my obstetrician and the fertility specialist who had performed my surgery. The cuts to my uterus put me at risk for uterine rupture.

But I always wondered if it may have been better to deliver her vaginally. I went into labor at 36 weeks and 6 days after weeks of “rumbling” (now known to be contractions) early in the morning. Throughout the morning I’d have a contraction, stop what I was doing, let it pass and then proceed. By mid afternoon, the contractions became regular and prolonged. I went to see my OB and when I had a 2 minute contraction that dilated my cervix 2 cm, I was admitted from her office.

When my daughter was born later that evening, she was only 5 lbs 3 oz and 18 inches long. I’ve always wondered if I shouldn’t have pushed her out. She was a tiny little thing and it’s hard to believe that a vaginal delivery could have been more traumatic than the scrambling that occurred after she was born due to my “profuse bleeding”. (They didn’t officially call it hemorrhaging, but I know my OB had a tough time closing me up because every time she tried to stitch, my uterus bled even more.) I’ve also wondered if the push through the vaginal canal may have in some way squeezed fluid out of her lungs and saved her the 10 day NICU stay for respiratory distress.

Seems like my musings may have in fact been correct. At the 32nd Annual Meeting of the Society for Maternal Fetal Medicine, researchers from Johns Hopkins University found that cesarean delivery provides no benefit for premature infants who are small for gestational age. According to a report in MedScape OB/GYN News,

Clinicians have commonly recommended cesarean delivery for infants who were premature and showed intrauterine growth restriction because it was considered more protective of higher-risk neonates than vaginal delivery.

However, a new study of neonates who were small for gestational age showed that cesarean delivery did not have fewer complications, and in fact had an increased risk for respiratory distress.

“I suspected there might be some benefits to each type of delivery, but it was a surprise to see no benefits…for [cesarean delivery], while there was a benefit for vaginal delivery in terms of less respiratory distress,” lead author Erika F. Werner, MD, MS, from the Department of Gynecology and Obstetrics at Johns Hopkins University in Baltimore, Maryland, told Medscape Medical News.

Dr. Werner and her colleagues also found other surprising outcomes as a result of cesarean delivery of premature, small for gestational age infants,

  • Cesarean delivery did not result in a reduction in the complications that have been perceived as risks with vaginal delivery
  • There is no reduction in neonatal death in infants born vaginally (as has been believed).
  • The odds of developing respiratory distress syndrome were 30% higher with cesarean than with vaginal delivery. The rate remained higher after controlling for factors such as the mother’s age, ethnicity, education, prepregnancy weight, diabetes, hypertension, and gestational age at delivery.
  • Infants delivered by cesarean had increased odds of having a 5-minute Apgar score below 7. No difference was seen after adjustment for confounding factors.
  • Cesarean delivery is associated with increased likelihood of future cesarean deliveries.

This is really important information. So often when a mama is having complications, the immediate medical response is immediate cesarean delivery to “protect” the health of mama and baby. Well, according to these findings by Dr. Werner and her colleagues, this is not at all the case. According to this report, the study was well constructed and had a hearty sample size such that the results are valid and able to be extended to the broader population.

So would this new information have applied to my daughter’s delivery? Technically speaking, my daughter was not small for gestational age, she was just small. Had she gone to term my OB reassures me she would have been closer to 7 lbs. She has no developmental delays or problems, yet does have asthma. Is this in fact due to her delivery? Both my husband and I have asthma histories and my husband’s history is quite severe. So what’s to say her asthma isn’t genetic? And who’s to say that my uterus wouldn’t have ruptured from the previous surgical cuts andscarring? Hindsight is in fact 20/20. But I will always wonder, “What if I had delivered her vaginally…?” Maybe I could have delivered my son vaginally as well!

For you Mamas on Bedrest who may be wondering if you should have a cesarean section, we can only suggest that you have a frank discussion with your doctor about these research findings and if medically reasonable, consider a trial of labor.

Note: This post was written based on information in the MedScape News, OB/GYN and Women’s Health, Society for Maternal-Fetal Medicine 32nd Annual Meeting. Nancy A. Melville was the author of the report.

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