Vaginal birth after cesearian-gestational diabetes

[admin]

A study was published this month in the American Journal of Obsetrics and Gynecology concerning vaginal birth after ceserian section for women with gestational diabetes.. The patients in the study were seen between 1989 and 1999. This is another of the reports about VBAC(vaginal birth after cesearian) that indicates a risk factor for a failed trial of labor. It is more common for women who have had a ceserian delivery(operative delivery) to require another in later pregnancies. Of course there are risks involved with a trial of labor, rather than a planned cesearian section(operative delivery)

What this study seems to be saying is that there are increased risks with attempting a vaginal birth after cesearian with a gestational diabetic, and that is more likely that the subsequent delivery with be operative(ceserian).

Hopefully this study and other similar studies, will force doctors to be more conservative and schedule more ceserian sections for women with gestation diabetes. To often doctors ignore warning signs, forge ahead and then encounter difficulty during delivery that could have been avoided.

Should you have any questions concerning the study, please do not hesitate to contact me.

Ken Levine
BRL77@world.std.com
617-566-2700

[admin]

Thank you Ken.

[marymom]

Im curious how you would feel if
you were a doctor and
the mother had gestational diabetes and practically begged for a C section because of information she had heard on this site and a past large baby so without even attemnpting to change the mothers diet with intensive nutritional counseling first you scheduled a C section and the baby suffered serios respiratory complications...respiratory complications are commonplace as a result of lack of normal labor stimulation to the lungs, something Im sure you are well aware.USUALLY they are minimal, sometimes they are fatal, what would you say then?

[francine]

respiratory complications are commonplace????

how commonplace? what are the statistics?

what types of respiratory complications? (and statistics of those)

[DebbieJean]

It is funny, that you brought up intensive nutritional
counseling. Do you know how hard it is for a gestational mom to regulate her blood sugars? Do you also know that Progesterone, cortisol, and human placenta lactogen increase the amount of insulin needed to maintain glycemic control. They are considered antiinsulin effects in a diabetic mom.
Now if the diabetes can't be control, insulin shots
are given. Diet alone can't control this, in everyperson. There are also the Somogyi effect,
that increases blood sugar in the morning. These
are all factors in gestational diabetes.

From what I understand, if the baby is taken close to the due date, the risk of respiratory problems is low.
I also understand the risk if greater for a bpi.
I would be really interesting to find out the stats on
respiratory distress with a c-section, and the risks
stats of a brachial plexus injury, in diabetic mothers.
My first two children had more complications related to a vaginal birth, than my last two children with a c-section. The funny thing is that with a vaginal the
baby actually "is under stress", during labor. That is a fact. Labor is not always a good thing.
I think we need to be informed of all information.
With my last two children (c-section),
I actually
1. got to hold them for the first time after birth.
2. got to breastfeed them after birth.
3. They had no meconium aspiration.
4 My "water" were clear, and not edematous.
5. They were not neonatal intensive care babies.
6. They got to go home with me, when I went home.
and all because I had them c-section.
There are advantages to c-section, not all bad.

[admin]

From 'Mothering' magazine Jan/Feb 2002 "Infections are the most common maternal complication after caesarian section and account for substantial postnatal morbidity and prolonged hospital stay. Other risks include massive hemorrage in 7.3% of cesarians, transfusions in 6.4%, ureter injury in 0.03 to 0.1 percercent, injury to bowels in o.5%, and incisional endometriosis in 0.1 to 1.0%. The Journal of American Medicval Association reported in 2000 that women who had undergone cesarian had twice the risk of women who had given birth vaginally of being rehospitalised for reasons such as uterine infection, gallbladder disease, urinary tract infections, surgical wound complications, cardiapulmonary conditions, thromboembolic conditions and appendicitis. Cesarian increases the risk of hysterectomy in both current and future pregnancies and more than doubles her risk of death compared to vaginal birth. A cesarian also dramtically increases the risk of severe pregnancy complications in subsequent pregnancies, for example placenta praevia, risk increases after 1 cesarian to 4.5x that of vaginal birth, after 2 cesars increases to 7.4x, after 3 risk is 6.5x and after 4 the risk increases to 45x more likely than with previous vaginal birth.
Risks for baby include respiratory distress syndrome (RDS) which is seen in 0.2% to 1.7% of term babies born by elective cesarian. Incidences are higher in infants of less than 37 weeks gestation. RDS is serious and life threatening, and often necessitates time in the NICU (average of 11.2 days). Levine et al found a fivefold increase in persistent pulmonary hypertension in neonates born by elective csection over vaginal births. Even higher incidences of RDS are found among preterm neonates delivered by elective c section. Physician caused prematurity is a known risk of elective csection, usually related to failure to conform to protocols for determining gestational age (NOT size) prior to delivery or errors in determining gestatational age even with the use of clinical data. (easily done, as virtually every story on this message board bears out) Most studies examine risks for very premature infants, but there are also significant risks for babies born between 32 and 36 weeks gestation. One recent study found that rates of infant death (from birth to one year) are increased 3 fold in the US for babies born between 34 and 36 weeks gestation, and 6 fold for babies born between 32 and 36 weeks. Less seriously, babies delivered by csection are at risk from by cut by the surgeon during delivery, 2 in 100 babies are injured in this way, increasing to 6 per 100 in the case of breech babies.

All of the references for these figures are contained within the article itself. Any physician who does not make a point of informing the parents to be of the risks, including to subsequent pregnancies, is not doing his or her job properly. Is there evidence that the rate of bpi injuries or neonatal death is lower in countries with a high c section rate?

[Connie&Andrew]

First of all, I may or may not have had gestational diabetes with my last baby. My 1 hour test was high, but my 3 hour test was within normal limits. But then my baby was 10 lb 9 oz. delivered 10 days early. But regardless I just thought I would share my thoughts on c-sections.

My first baby was breech.(This was 1983). My water broke and several hours later I still had not started into labor. My doctors policy was that breech babies were taken by ceserean (especially first ones). I agreed and he was born c-section.

My second baby was due in 1986. At the start of my pregnancy the small town I lived in did not allow vaginal birth after c-section, but partway through my pregnancy they agreed to allow me to try. I did try a vaginal birth, but wasn't successful. There are a number of factors I believe led to this, which I won't go into here. The baby was 9 lb 9 oz. He was born ceserean.
My 3rd baby (1988). I attemped a vaginal delivery again and was successful. I then had a 4th baby (1990) vaginally and he was 9 lb 1 oz.

It was nine years later when I became pregnant with my 5th child (my BPI baby). We knew that he was a big baby, but the doctors didn't really mention doing a planned c-section. The ironic thing is that I don't think I would have agreed to a planned c-section even if they had suggested it. I had fought so hard for the right to a vaginal delivery after 2 c-sections and I really believed that was the right thing to do. I guess now I wish I had had a c-section, but I think even if they would have told me there was a risk for a brachial plexus injury, I would have said I at least wanted to try a vaginal delivery.

I guess my point is that there are so many factors depending on our experiences. People who have had problems with c-sections are fighting for the right to vaginal deliveries. People whose babies have been injured during vaginal deliveries fight for the right to a c-section. Sometimes we think that we know what is best for others based on our experience. I don't think there is any one right answer.
Just a side note, My sister's baby was cut during a c-section. He had a large scratch all the way up his arm. The doctors said that it was fine, that you wouldn't even be able to tell in a few months, but he still has a scar now (He turns 3 this month). There are so many things that can happen and that can go wrong.

I guess we just need to research and then do what we feel is best for us.

Thanks for listening.
Connie

[m&mmom]

Connie,
With you three hour did your ob use the carpenter-coustan conversion? All of your results need to be looked at separatley. My baby was 10lbs 6oz two weeks early (induced) and his lungs were not developed. Typical pattern for a gd baby. My one hour was also high.

Back to the topic -
I have two cousins born via c-section both suffered from resp. problems then developed pneumonia.
Cindy

[francine]

well what I have learned from this is that birthing period is very risky stuff - whether you do it vaginally or abdominally it's risky stuff and you had better have a GREAT practitioner helping you out with it... and HOW are we supposed to find those GREAT practitioners I wonder. Are they far and wide - or are some good ones really out there. I'm glad my store is closed now....but I worry for my daughters.
It's a sad state of affairs if you ask me.

-francine

[Bridget]

I think Connie makes an EXCELLENT point, each of us deserves the right to make our own informed decisions about what is best for ourselves and our bodies, and that decision will be different for everyone, depending upon many factors.