There are two types of cesarean births—planned and unplanned. Most primary (first-time) cesarean births are unplanned. Many of the same routines are followed for both types of cesareans, although they might be done in a different order and often somewhat more hurried in an unplanned cesarean. When dealing with an emergency cesarean, more stress is involved, since the woman has not had adequate time to prepare emotionally. If she is separated from her labor partner during delivery, the trauma of the experience is intensified.
A planned cesarean birth is usually scheduled to occur just prior to the anticipated due date. Early confirmation of pregnancy and accurate documentation of fetal growth are essential for determining the date precisely.
Because the due date is only an estimate, prematurity is a risk. Premature babies are more likely to develop respiratory distress syndrome (RDS) and are generally less able to handle life outside the uterus than full-term babies. They are therefore more likely to be kept in the hospital for an extended period of time, separated from their mothers and fathers. This increases the new parents’ anxiety about the birth experience and inhibits bonding with the baby.
If you will be having a planned cesarean, request permission to go into labor spontaneously. Labor is the best indicator that a baby is adequately mature and ready to be born. RDS has been found to be “four times less frequent in babies that were delivered after labor had commenced than in those that experienced no labor.” Labor contractions stimulate the baby’s body, better prepare his lungs for breathing, and reduce his chance of respiratory difficulties. Since the contractions also draw up and shorten the cervix, many doctors feel that an incision made in this area is the strongest one possible and offers less chance of rupture if a vaginal delivery is attempted in the future. When labor begins, call your doctor at once. Do not labor at home.
Doctors can perform several tests to help determine fetal maturity and therefore lessen the risk of delivering prematurely. Your doctor might choose to do a sonogram in order to measure the biparietal (ear to ear) diameter of the baby’s head. With this measurement, the doctor can estimate gestational age. The accuracy of the test depends upon when it is done. It is most accurate when performed early in pregnancy.
Some doctors also perform amniocentesis to assess the maturity of the baby’s lungs. This test evaluates the amniotic fluid for the proportions of lecithin and sphingomyelin, substances that are produced by the lungs. The proportion of lecithin to sphingomyelin is called the L/S ratio. This ratio changes toward the end of pregnancy, with a sudden increase in lecithin occur¬ring after 34 weeks. A ratio of two to one or greater indicates lung maturity in the baby. A sonogram should be done in conjunction with amniocentesis to locate the placenta and the baby.
In certain high-risk conditions, such as diabetes and PIH, the placenta begins to deteriorate prior to term. In these cases, serial estriol levels can be measured to determine placental function and fetal well-being as an indicator of the best time for delivery. The biophysical profile is a more recent test used for determining optimum time for delivery.
Since the American College of Obstetricians and Gynecologists has recommended that all women without medical contraindications attempt a vaginal birth after a cesarean, the number of planned cesareans is decreasing.