To "C" or Not to "C"...That is the Question

by Michael J. McGlynn, Jr., M.D.

There is certainly no shortage of medical advice for expectant mothers when it comes to nutrition, exercise and maintaining a healthy pregnancy. But the information about choices to make as pregnant women enter into labor and delivery is not as straightforward. Questions about the birth process and whether to accept pain medication during labor or bypass labor altogether and have an elective caesarian section are very personal choices.

As women approach labor and delivery questions arise concerning labor induction, cesarean sections versus vaginal birth, and pain management.

More and more pregnant women are requesting caesarean sections without labor. This is especially true for first time mothers who are apprehensive about the pain associated with labor as well as injury to the birth canal with a vaginal birth. Many mothers also want a C-section to control the delivery date. Today C-section is the most commonly performed surgery in the U.S.

While OB/GYNS recommend a vaginal birth most of the time there remains certain indications for c-sections. Abnormalities on the fetal heart rate monitor may indicate that the baby cannot tolerate labor and a C-section is warranted. Some OB/GYNS recommend c-sections to their patients to avoid the risk of perineal trauma during vaginal birth, which may cause uro-genital or anal incontinence.

Other indications for C-section include the fetus weighing more than 9.5 lbs (if the mother is diabetic); the fetus being in a breech position; or the risk of transmitting infectious diseases such as HIV.

For vaginal births women are choosing epidurals, which are safe and effective for getting through labor and delivery with significantly reduced pain and discomfort. This is the most commonly used pain management in labor. However, epidurals may also slow down the labor process. Pregnant women are encouraged to discuss all the various options for pain relief with their physicians.

While inducing labor should be avoided as much as possible there may be times when labor induction is appropriate. Such situations may include uncontrolled hypertension, severe pre-eclampsia, poorly controlled diabetes, history of a prior stillborn, abnormal fetal growth or development, or a pregnancy lasting longer than 41 weeks.

Also the practice of episiotomies, which involves snipping the skin of the perineum and enlarging the vaginal opening to make it easier for the baby’s head to emerge, has become largely unnecessary. Doctors have learned that the natural tearing of the woman’s vagina is far less traumatic than the effects of an episiotomy, which many times takes longer to heal, leads to more severe lacerations, and can make motherhood far more painful and awkward than it has to be.

With so many decisions to make, pregnant women should be comfortable enough with their obstetricians to make sure they can get all their questions answered, even writing questions down in advance. After all, a healthy mom and a healthy baby is everyone’s ultimate goal.

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Dr. McGlynn is board-certified in obstetrics and gynecology, and has been delivering babies at Eden Medical Center in Castro Valley for 22 years. For more information call (888) 445-8433