C-Section No Cure-All for Problem Births
For Prolonged or Halted Labor, C-Section Not Clearly Better Than Instrument Delivery
Difficult Birth, Difficult Choice continued...
This doesn't surprise Audra Timmins, MD, assistant professor of obstetrics and gynecology at Baylor College of Medicine in Houston.
"In someone who has gone all the way through labor and has pushed and pushed, a C-section doesn't save you anything," Timmins tells WebMD. "All the damage is done. There is no benefit to a mom. And the recovery is longer after a C-section."
That's because an emergency C-section is very different from a planned C-section, says Julian N. Robinson, MD, attending physician at Brigham and Women's Hospital in Boston and director of maternal and fetal medicine at Newton-Wellesley Hospital.
"If you look at C-section at the onset of labor, it is straightforward and simple. But at full dilation that is not the case," Robinson tells WebMD. "For the obstetrician, it is a very difficult scenario. C-section is not an easy option for a woman at full dilation. You are between a rock and a hard place. Forceps and vacuum delivery may be challenging, but C-section may be challenging as well. These are the C-sections that women have the most complications from."
Making the Choice
At her institution, Timmins says, the policy is for pregnant women and their doctors to discuss what might happen during labor long before the event.
"Basically, if I am comfortable that mother and fetus met all criteria for safe forceps delivery, I will offer them a trial," Timmins says. "If they have strong opinions, and say they don't want them used, we don't use them. We don't force them on anybody. But most of the time women and their partners understand that, in well-trained hands, a forceps or vacuum delivery is just as safe as a C-section."