Those Pre-Natal Jitters
Those Pre-Natal Jitters
October 8-22, 1986
By Nutan Pandit
Most over anxious mothers-to-be would rather opt for a caesarean section than try for a normal delivery thus complicating a normal biological process. Yet there are few conditions that justify a caesarean.
When a woman out of choice, decides to have a caesarean operation at the time of delivery, it is called an elective caesarean. Sometimes, it is due to over-anxiety on the part of the mother.
For instance, take the case of Sheila. She conceived seven years after her first baby was born. A lot of waiting and a number of visits to the doctor had finally borne fruit. Sheila was nervous. Her first delivery was a caesarean because the baby’s heart beats had become faint. So when she was pregnant the second time, she opted for a caesarean again, since she didn’t want to take any risks. But the point is, is delivery a risk? Is it not a normal biological process of the body? Sheila’s story has a sad ending because her baby died when it was barely a month old, of a congenital defect. That is, an inherent defect the baby was born with – in this baby’s case, it was a defect connected with the heart.
Sheila would have had a normal delivery after a first caesarean, since the reason for her earlier caesarean was distress in the baby’s heart beat, which need not repeat itself the second time. If Sheila had some basic irrevocable defect, like an abnormally formed pelvic bone, she would have needed a caesarean for all her deliveries. If a woman has had a previous caesarean, not because of a basic defect she can try for a normal delivery the second time. But it is advisable that she have her second delivery in a hospital and not in a private nursing home
Another interesting incident is that of Bani. She got worried because she thought her baby was kicking less. Incidentally, movements do get to be from wild kicks to mild knocks about 15 days before the birth of the baby. The reason being that the baby’s head fixes in the brim of the bony pelvis and so there is less possibility for the baby to move, it is like leashing a puppy! This is also called the engagement of the baby’s head. It is accompanied by the stomach protruding more from the lower half and by a feeling of comfort at the waist, below the breasts as opposed to the earlier discomfort there.
Any way, it made Bani very nervous and she rushed to her doctor. Her doctor put her on oxygen for a couple of hours and when she was being discharged the next day, said, “Good you came, you might have been sorry.”
Those words sent Bani into a mighty panic. The next day, she went to her sister-in-law’s doctor for a second opinion. He told her everything was fine and she need not worry. She changed doctors.
She began getting contractions or pains at 6.30 in the evening, and checked into the nursing home. When the doctor came to check her, he said there was only a 10 per cent chance of a normal delivery by next morning, since the baby’s chin was up instead of towards the chest. Would they like to wait? So her family decided they would rather have a caesarean and at 10.20 that night, the baby was born by a caesarean section.
Now, one thing is sure, a first-time mother can easily have 24 hours labour before she delivers normally. What the doctor explained is in medical terms called a brow presentation. A brow presentation is unstable and tends to convert to either a face presentation or a normal presentation. A face presentation can pose a problem because the baby comes out with his head thrown back. In that case, the presenting diameter of the head and shoulders together causes an obstruction. However, the combination of a small fetus in a roomy pelvis may permit birth. So, may be if Bani had waited, she might have had a normal delivery.
Then, there is the case of Neelam, who is an obstetrician herself, who chose to have a caesarean and when she talked about it in her pregnancy, she said that she did not mind the pain – she knew she would not fuss if she had to go through it. However, she felt her hips, like her sister’s were narrow. Her sister had a caesarean. She thought her pelvis too was android, that is, more like a male pelvis.
But after the caesarean, she gave different reasons for her choice. She said she had taken into account her late age since she was pregnant six years after marriage. Also, that she had spotting and baby’s head was not fixed. Pain, she said, was no problem because of the new technique of epidural anesthesia. She didn’t want to take a risk, so she opted for a caesarean.
One of the reasons for caesarean section is, when the baby’s head is too large to pass through the pelvis, or the pelvis is too narrow to accommodate it. Medically it is called cephalopelvic disproportion.
High blood pressure or hypertension in the mother could require caesarean section. Lowering or acceleration of the baby’s heart beat may also lead to an emergency abdominal delivery. Some obstetricians prefer to deliver all breach babies (that is, babies that are lying feet first, instead of head first), of first-time mothers by caesarean section. Similarly, abdominal delivery may also be resorted to in the case of twins, low birth weight babies, placenta previa, failed induction of labour or women suffering from diabetes.
There are two kinds of incisions used for caesarean delivery – longitudinal from a point below the navel to a point above the pubic hair or the transverse, usually low down on the edge of or below the public hair line. The later is known as bikini cut. Of the two types of incisions, most women, if they have a choice, opt for the latter, since it is scarcely visible once the hair has grown back.
A healthy young woman of childbearing age, should have little difficulty getting through her pregnancy with little or no interference from doctors or hospitals. However, there are certain exceptions to this general rule which must be taken into account, for there are times when caesarean operations are life savers for mothers or babies.
To be able to understand the doctor’s dilemma and to discuss it with her or him, it is important for the patient and her husband to be well informed. One way of being well informed, is to read books on the subject. Another way is to attend childbirth preparation classes.
As long as the baby’s heart beats are normal, that is, between 120 to 160 beats per minute, there is nothing to worry about. Medically it is called FHR i.e. fetal heart rate.
Remember your estimated date of delivery, is not a date of appointment. You can deliver two weeks before or two weeks after it. Do not get anxious if you go over your due date. The due date is worked out on an average basis. To illustrate my point, the average age of girls starting menstruation may be 12 years but that does not mean it is abnormal if a girl menstruates at 11 or 13 years instead. It is not advisable to wait for more than two weeks, as the efficiency of the placenta (the organ that nourishes the baby) tends to diminish by then.
The mouth of the uterus, called the cervix, is softened in readiness for labour. Medically this is called “effacement” of the cervix. If labour is induced i.e. stimulated to occur by injecting synthetic hormones in a pregnant woman, the induction is likely to result in a normal delivery. But if the cervix is stiff, when labour is induced, it is likely to culminate in a caesarean.
Last, but not least, please do not make a big fuss about who receives the baby. If the baby arrives before the doctor has come in, it’s a sign that everything is perfectly normal. Doctors are very busy people. If your doctor for some reason gets delays, there will always be a doctor on duty at a hospital or nursing home, you won’t be on your own. Remember your body is designed to give birth to a baby. Three joints of the bony pelvis move away to let the baby out. The vagina is made up of folds that open up much as a bud blooms into a flower. And the baby’s head moulds itself to the size of the mother’s passage, in order to be born.
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