Evidence Based Practice of Repeat Cesarean Sections and Vaginal Births after Cesarean Section - Essay Example

Evidence Base Practice of Repeat Cesarean Sections and Vaginal Births after Cesarean Section The reproductive health sector has undergone enormous changes in the recent past. Specifically, child bearing procedures have become safer for both the mother and the child. This is the general analysis consideration, meaning that unsecure child bearings have been experienced. Contemporary times have seen an increase in cases of cesarean, and a decrease in that of vaginal births. The natural way of giving birth is slowly being replaced by cesarean section. The important aspect to highlight in each of the two is the underlying benefits and risks of each method of child birth. There have been observed cases of repeated cesarean as well as that of vaginal birth after cesarean section (VBAC). These aspects will be explored in this paper and evidence of practice presented. Repeat Cesarean Sections Health care specialists have noticed the rising cesarean numbers around the world. These specialists alongside other associate experts have begun campaigns to advocate for reduced cesareans. Women have intentionally and unintentionally opted for cesarean sections. Some cesarean sections have been involuntarily administered, while others have been termed voluntary. When a woman is on labor and fails to give birth the normal way, surgical teams have been availed to address the issue by carrying out a C-section in a bid to assist the mother. Some cesareans have been carried out on voluntary grounds. Women who are capable of delivering normally have had to undergo cesarean section by choice (Menacker 2003). Cesarean sections have increased maternal-newborn health complications. Surgical procedures have been associated with a number of complications that affect both the mother and the newborn. Increased cesareans have also resulted to increased cost of health care especially in the US. This is so due to the health care financing modes of the different states. However, whether the C-section is intentional, unintentional, voluntary or involuntary, the benefits and risks of its practice are important to consider. It is also important to outline what benefits and risks relate to planned or unplanned cesarean. An unplanned cesarean is carried out during labor, when it is established that the mother is not in apposition to deliver normally. This has been termed as an emergency in many reproductive health care institutions. Surgical teams are provided in delivery rooms in case of an emergency. On the other hand, a planned cesarean is a voluntary one. The woman prefers to undertake a cesarean instead of going through the natural birth giving process. Medical researchers have proven this type of cesarean is safer than the unplanned. Infections and surgical injuries are not often reported as it is the case in unplanned cesarean. Fewer risks therefore characterize planned cesarean compared to the unplanned cesarean. Repeat cesarean sections are deemed as a gateway to increased health risks and complications. Several cesarean procedures have been said to affect the mothers’ physical statue negatively. Repeat cesarean patients have had to spend more days in hospital compared to vaginal birth patients. Their emotional welfare has been comprised especially when complications emerge. Resultant complications have relatively affected other aspects of motherhood, including breast feeding and the health of the newborns. Health issues in these babies may start when they are young and consistently become complex as the children grow and develop (Guise, 2004). On the same note, future productivity of mothers has been comprised. Complications and the occurrence of emergencies in women who have had several C-sections are higher compared to those women who give birth the normal way. Although repeat sections have been prevalent in the recent times, women who ought to do it should gather enough information about the procedure. Many medical researchers have published their results on the prevalence of repeat cesareans in America and around the world. These researches present diverse, dynamic and sufficient information that is useful in guiding women on the best delivery methods. Although an emergency may not allow for a normal delivery, medical specialists have been vocal in advocating for vaginal deliveries. Repeated cesareans make the situation worse for the woman, thus the advocacy of a normal delivery procedure rather cesarean, whether it is done for the first time or it is a repeat. However, during an emergency, the situation is critical and therefore it is should be upon the medical team to decide which is the best way out. Vaginal Births after Cesarean (VBAC) Successful cases of VBAC have been reported in many reproductive health care facilities. VBAC is actually possible, but the underlying benefits and risks need to be analyzed well before hand. This procedure is efficient in health facilities that have complex infrastructure and appropriate medical technologies. On the same note, the emergency medical team is well structured and organized to address any case of emergency that may result from a failed VBAC trial. Obstetricians’ recommendations of possible VBAC have been effected, but it is important to note that they have not been functional in all reproductive health facilities. This is because the procedure is risky and it is also associated with major health complications in its context. Women who have previously had a low transverse cesarean segment should be allowed a VBAC trial. However, failure to realize the desired results in such a case attracts a legal liability. Qualified facilities are often redundant in effectuating this procedure because the underlying risks surpass benefits by great margin. Furthermore, the probability of the occurrence of uterine rapture is high, thereby acting as a significant barrier to the practice of VBAC. As much as women who had one or several C-sections would want to undertake a VBAC, they should understand the characteristic risks that they pose to themselves. On the same note obstetricians’ sensitivity to maternal and fetal health is prioritized during a labor trial (Hager, 2004). Prediction on uterine rapture must be ultimately defined in order to state the degree of success of the VBAC. It is important to note that the predictions made not always hold up to the expectations of the health care specialists. An emergency surgical team must therefore be put up during such trials so that if need be, the trial is aborted and cesarean undertaken immediately. VBAC is presented as a trial by health practitioners. This is due to the fact that information on benefits and the risks involved are adequately passed to women who have had C-section(s) before and they would want to try VBAC. Women who have had cesarean section before and underwent no complication would prefer to take another cesarean rather than a VBAC. Maternal rejection of VBAC has been based on a number of factors as presented by both patients and health practitioners. First, uterine rapture is common during this procedure. Vaginal births after cesarean have been successful in several instances, but the number of failed attempts is worrying. Newborn morbidity has been another concern when it comes to VBAC. Although many women would want to undergo a VBAC, child morbidity have drawn many mothers back to having cesarean; one after the other, even when they would have had a successful VBAC. A number of women also fear giving birth in the normal way due to the associated pains and additional surgeries (Dodd, 2004). As a result, maternal rejection of trying labor after successive cesareans characterizes VBAC. Individual decisions are important to consider in assessing whether or not a woman should try labor after one or more cesareans. Maternal welfare alongside that of the newborn is fundamental to highlight in order to avoid possible dangers. VBAC should be undertaken when all the parties bound to it are lest assured that it is safe and risks of complications are minimal. As much as women who have had cesarean are encouraged to take a labor trial, it is upon them to decide what mode of delivery is safe for them and their babies. References Dodd J, Crowther C. Vaginal birth after Caesarean versus elective repeat Caesarean for women with a single prior Caesarean birth: a systematic review of the literature. Aust N Z J Obstet Gynaecol 2004;44:387–391. Guise J, McDonagh M, Osterweil P, Nygren P, Chan B, Helfand M. Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section. BMJ 2004;329:19–25. Menacker, F. Trends in cesarean rates for first births and repeat cesarean rates for low-risk women: United States, 1990-2003. Natl Vital Stat Rep 2005;54:1–8. National Collaborating Centre for Women’s and Children’s Health. Caesarean Section. Clinical Guideline. London: RCOG Press; 2004. Hager, AK Daltveit, et al. Complications of cesarean deliveries: rates and risk factors. Am J Obstet Gynecol 2004; 190: 428-34. Read More