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Cesareans for prematurity?

1K views 17 replies 13 participants last post by  snowbird25ca 
#1 ·
I've often heard of people having cesareans, often classical, when babies are quite premature. I understand this when there is a health problem necessitating immediate delivery, but if I've understood right, it's also often done when the problem is premature labor. I looked around pubmed for studies supporting or explaining this practice, but didn't come up with anything (may not have thought of the right terms, though).

Does anyone know whether and why this would be common practice? Is there research showing that it improves outcomes?
 
#4 ·
I want you to note that this is a study by published in a ped magazine-- the person likely to do a c-section is an OB-- doing a c-section protects a doctor from law suit more so than not doing one- especially in a baby that is not likely to make it-- people at a trial really do not know much about medicine nor does a judge--

Pediatrics. 2006 Dec;118(6):e1836-44.

Survival rates and mode of delivery for vertex preterm neonates according to
small- or appropriate-for-gestational-age status.

Lee HC, Gould JB.

Division of Neonatal and Developmental Medicine, Stanford University, 750Welch Rd, Suite 315, Palo Alto, CA 94304, USA. hclee@stanford.edu

. CONCLUSIONS: Cesarean section delivery was associated with survival for preterm small-for-gestational-age neonates but not preterm appropriate-for-gestational-age neonates. We speculate that vaginal delivery may be particularly stressful for small-for-gestational-age neonates. We found no evidence that prematurity alone is a valid indication for cesarean section for preterm appropriate-for-gestational-age neonates.

PMID: 17142505 [PubMed - in process]
 
#5 ·
I just had a c-section at 27 weeks 6 days, because my dialation would not stop even though the contractions did. I could have had a vaginal birth IF the baby had been in the right position but he was coming out foot first. I have heard that the contractions (compression) on the baby help produce hormones in to help them breathe. But in our case I felt that he was too little and we were unsure about the maturity of his lungs to take the compressions, and of course he was foot first. He is doing really well and has been breathing on his own since he was born last Tuesday. He is over a week now and his biggest problem is that he is not gaining weight as fast as I would like but his doctors and nurses are very pleased with his progress.
 
#6 ·
It's common for pretermers to be non-vertex, and a classical incision is the only option for section when the lower uterine segment (LUS) hasn't developed yet (also common in preterm pregnancies).
 
#7 ·
C-section is valid for a premature baby who is doing poorly in the womb or when the mother is ill, (ex. pre-e, IUGR). When the delivery hasn't started on it's own and conditions for mother and/or baby's health is be compromised by the pregnancy.

Imminent preterm birth is generally better served by a vaginal birth if the baby is vertex and the labour is progressing well (cervix dialating well). Prematurity itself is not an indication for a c-section.

My son was born at 29 weeks, vaginally. It was a very quick birth. I have no doubt if tere had been ANY bumps along the way, I would have been offered (ordered) a section.

The only complication I've heard of with prematurity and preterm labour is that the cervix does not dialate properly b/c there is not enough weight on the cervix from the head.

Just from my own reading and my midwife's comments.
 
#8 ·
My understanding is that c/s is done when preterm labor cannot be stopped and the baby is young enough that vaginal birth might be harmful to the baby, due to the immaturity of its skeletal system.

I haven't searched for links to back that up, but have been given that reason by several people.
 
#9 ·
Quote:

Originally Posted by funshine View Post
My understanding is that c/s is done when preterm labor cannot be stopped and the baby is young enough that vaginal birth might be harmful to the baby, due to the immaturity of its skeletal system.

I haven't searched for links to back that up, but have been given that reason by several people.
I heard this before too, but both the OB that delivered my son and my midwife said it is competely incorrect. Vaginal birth would not be inherently more dangerous to the skeletal system than c-section. It makes sense, especially since the baby's bones are not ossified (they're like rubber in fact).
 
#10 ·
I recently read a birth story of a premature baby that has been bothering me. The baby was transverse, the mother was having contractions but not dilating even after they ruptured her membranes, so they did a c-section.

Why didn't they just wait and see? I know from my own births that prodromal labor can go on for days, and the docs can't tell it from the real thing. As long as the baby was ok, why didn't they just leave it in there? I would think that every hour the babe was still inside was a blessing. If the baby is not in distress, the contractions aren't hurting it are they?
 
#12 ·
Quote:

Originally Posted by etoilech View Post
C-section is valid for a premature baby who is doing poorly in the womb or when the mother is ill, (ex. pre-e, IUGR). When the delivery hasn't started on it's own and conditions for mother and/or baby's health is be compromised by the pregnancy.

Imminent preterm birth is generally better served by a vaginal birth if the baby is vertex and the labour is progressing well (cervix dialating well). Prematurity itself is not an indication for a c-section.
That was the case with my c/s. Both DD and I were not doing too well. IUGR causes the risks for placenta abruption to be sky high. There was concern that if I went into labor DD would not tolerate it, or it would make my already questionable placenta to fail or abrupt.

I was also told there was concerns that DD's skull would not tolerate a vaginal delivery.

Also, at 34 weeks, my body had no plans to go into labor at all. My ob said she could put me into labor, I'd be miserable for 8 hours then have an emergency c/s, best case senario. Worst case senario was the aburption or placenta failure. MY cervix was still high and tight, never even had a contraction, so we had the c/s. DD had to be born. I did have the horizontal incision, but my OB said this was a decision she would make when she was in there, as she could not tell if the lower portion would be thin enough to do the horizontal incision.

A vaginal birth would have likely killed DD, and possibly me. Please remember that when you are thinking about these questions, with a premature birth, lives are on the line. I would rather have us both here and healthy than have a vaginal birth. Please don't judge those moms put into this awful situation of having a pregnancy which does not go well and healthy, and where we must have medical interventions to save lives.

If a mom is already in labor, it does make sense that a vaginal birth would be the best, all things equal. When dealing with a early birth you may also be dealing with spina bifida, Pre-E, HELLP, a body not ready to labor, fragile baby, unwell mommy.
 
#13 ·
As I said above, I understand the c-section for prematurity when mum and/or baby is sick and labour is not imending, however, prematurity itself is NOT neccessarily an indication for a c-section.

Contrary to popular belief even very small preemies tolerate vaginal birth (barring illness as previous poster described). They are not as physically fragile as we think. I am surprised, intorainbowz, that they pulled the whole skeletal integrity thing with you. It's been debunked through research, in a couple studies now (obviously barring something like brittle bone disease). There have been a few that have shown premature babies BENEFIT from a vaginal delivery.

I do do agree when mum and/or baby are doing poorly, and there is no sign of labour... c-section is an obvious choice.

What I can't fathom is why sometimes doctors offer to induce. Nuts. I figure if you or babe are so sick that the baby has to come now... do a c-section.
 
#14 ·
Quote:

Originally Posted by etoilech View Post
What I can't fathom is why sometimes doctors offer to induce. Nuts. I figure if you or babe are so sick that the baby has to come now... do a c-section.
Um, because even an induced vaginal birth is safer than major surgery?

I was offered an induction for severe PE and breech, and opted for a section because of the breech. But if he'd been vertex there's no WAY I would have ever chosen a primary section.
 
#16 ·
Quote:

Originally Posted by maxmama View Post
Um, because even an induced vaginal birth is safer than major surgery?

I was offered an induction for severe PE and breech, and opted for a section because of the breech. But if he'd been vertex there's no WAY I would have ever chosen a primary section.
Yes, vaginal birth IS safer. There is no doubt about that. Induction is very stressful for the baby and the mother. The contractions are much stronger and unnaturally hard. The placenta can compensate for normal contractions, but one of the reasons there are so many cases of abnormal heart tones and thus c-section is due to the placenta not being able to properly compensate with oxygenated blood during these very hard, strong contractions. The baby is also stressed and I would be worried about meconium and a preemie.

In my own opinion, I feel induction on a sick mother and/or baby is irresponsible and c-section is one instance where it makes more sense.

If you had pre-e I am surprised they weren't worried about your blood pressure shooting up due to the stress. Pitocin is pretty nasty stuff. I am really happy that both you and your baby are fine.
 
#17 ·
I had a 25 wker vaginally. In my instance my health wasn't at risk or the baby's. I was told I could do a vaginal only if the baby was head down, luckily she was at that time. They never said anything to me that a c-sec was better for the baby, but actually they said the reverse since I wanted no pain medications. They stressed that no pain meds during the delivery would be better for my preemie and she did come out pretty active and kicking and trying to cry. Now I think if I had a c-sec and maybe the outcome wouldn't have been as good?
 
#18 ·
I had PPROM at 32wks with ds and went into labor at 33wks and 1 day and delivered him vaginally. I was stuck with constant fetal monitoring though because of the low/almost non-existant amniotic fluid level.

I do think there's something to be said that a smaller baby creates less pressure on the cervix and so dilation happens slower. His labor was definitely slower than dd's, although the ctx were much stronger. Although my labors aren't long by any stretch of the imagination.
 
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