When I learned that I am carrying twins, I knew right then that I will not be able to experience natural birth. The initial ultrasound revealed that both of my twins are in breech position (the leading parts are buttocks instead of the heads). Although their presenting parts can still change as they grow inside my tummy therefore the chances of vaginal birth is not nil, my mind is already fixed at having them delivered via a scheduled cesarean section, which my obstetrician also strongly concurred.
Some of my family and friends expressed apprehension regarding the C-section. “Are you not afraid of subjecting yourself to a major surgical procedure”, they asked. I thought to myself, who wouldn’t be, especially that I know exactly how it is done because I am a doctor myself and have assisted countless C-sections and have seen the worst. But I persuaded my mind and medicated my human fear with much rationalization that C-section is the best choice there is.
There are many reasons why cesarean delivery is recommended and it includes the following:
• Labor is not progressing as it should (e.g. weak contractions, baby is too big)
• The baby’s condition is not tolerating the stressful condition of labor
• The baby is not in a favorable position (buttocks first) for a vaginal birth
• Heavy vaginal bleeding, in the case of abruption placenta (placenta separates from the uterus before the baby is delivered) and placenta previa (placenta is covering the cervix)
• The mother had previous cesarean delivery or other surgical procedures wherein the uterus was cut open
• There is a mechanical obstruction that prevents vaginal birth (e.g. myoma, pelvic fracture, cervical cancer)
• Mother has an active genital infection like Herpes or HIV which can be transmitted to the baby during vaginal birth
• Multiple gestations (twins, triplets, or more)
C-section may seem dangerous, but knowing how it is actually done will prove that it offers a far more controlled and relax atmosphere with fewer unknowns and uncertainties compared to undergoing actual labor. After being admitted to the hospital, a woman will meet with her anesthesiologist who will perform skin testing for any allergic reactions of the anesthetic drugs to be used for the procedure. This visit will also allow the anesthesiologist to identify any medical problems that might affect the type of anesthesia to be used. The patient will be asked not to eat or drink post midnight before the procedure.
Few hours before the operation, a woman may be given medications which will decrease the stomach acidity and the oral and nasal secretions. An intravenous line will be inserted into the hand or arm, and an electrolyte solution will be started. In the operating room, monitoring devices for heart rate, blood pressure, and blood oxygen level will be hooked to the patient. If allowed, the husband can stay in the operating room.
Generally, a regional anesthesia (done by injecting an anesthetic at the back around the spine to numb the body) is preferred because it allows the woman to remain awake during the procedure, experience the birth, enjoy the support of family and staff and have immediate contact with the newborn. Regional anesthesia is safer than the general anesthesia, which induces unconsciousness and carries a greater risk of complications. Then, a catheter is inserted into the urethra to drain out the urine reducing the chance of injury to the bladder. This will be removed within 24 hours of the procedure.
Once the body is numbed, two incisions will be made by your obstetrician: one on the skin and another on the uterus. As soon as the uterus is opened, the baby is removed within a minute, and the placenta is evacuated. The incisions will be closed and the wound is expected to heal over the next few weeks. The mother can usually go home within 3 days after delivery.
Although many mothers have successfully given birth to their twins via vaginal delivery, in my case I don’t want to take chances. It is better to err on the safer side. The risk of C-section is very minimal compared to the risk you and your baby will be facing if it is highly indicated and yet not done.
Remember, doctors agree that vaginal birth is still the best method of delivery. But if your doctor recommends C-section, he or she must have good enough reason to do so, which is to save the life of you and your baby from delivery complications. So if your doctor recommends cesarean delivery, try to relax, sit back, and be assured that you are in good hands.
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