Obstetrics

What Happens to The Immune System During Pregnancy?

Your immune system has one basic function: to keep you healthy. By using a complex array of biological tools and weapons, your body can fend off most invaders, including viruses, bacteria, and the occasional fungus. 

But pregnancy introduces some additional complexity for all those t-cells and antibodies (not to mention the scientists and doctors that study them). Your immune response to something like a cold or flu may be different when you’re pregnant than you would normally expect. So, knowing more about typical pregnancy immune system responses can help you better plan for your nine-month term.

After all, keeping your immune system in tip top shape is a way to keep you and your baby healthy. 

An Evolving Understanding of Your Pregnancy Immune System

Scientists used to think that women’s immune systems became weaker as pregnancy progressed. To these researchers, it seemed logical to think about the fetus as a kind of transplanted organ. 

When an organ recipient gets a new liver or lung or heart, the patient must take immunosuppressive drugs for the rest of their life. This stops the immune system from seeing the transplanted organ as a threat and initiating an immune response (a process known as rejection). A fetus must require the same kind of protection, researchers thought, which meant that immunity during pregnancy must be diminished.

Relying on Your Immune Response

But new research suggests that this is not what happens when you become pregnant. At least, not exactly. 

Modern scientists and researchers have observed that the interaction between your pregnancy and your immune system is much more complicated than first suspected–in many ways, it’s a kind of complex dance. 

This dance between your body, your baby, and your immune system continues throughout your pregnancy. And there are certain aspects of your immune response that actually become stronger when you’re pregnant. For example, we now know that implantation of the embryo in the uterine wall cannot happen without a strong immune system reaction. That immune response causes inflammation in the uterine lining (the same type of inflammation that results from an injury) which is essential to successful implantation.

Will You Feel Sicker?

Further research has reinforced the notion of a particularly strong immune system for pregnant women, suggesting that the initial 15 weeks of pregnancy depend on a potent immune response. 

Some studies have even shown that the presence of various types of T-cells increase while you’re pregnant. These T-cells (or white blood cells) are responsible for a few different aspects of your immunology. Regulatory T-cells (or Tregs) and so-called killer T-cells are just two types–and during pregnancy your body promotes and amplifies production of each.

During the course of your pregnancy, your body’s immune system will work hard to protect both you and your baby. But that doesn’t always necessarily work in your favor symptomatically. Scientists have known for some time that ailments such as the common cold or influenza tends to hit pregnant women harder than non-pregnant women. 

The assumption always used to be that this was because pregnant women’s immune systems were weaker (again, working on that organ transplant-like situation). The reality, however, is that colds and flus tend to be more severe in women because their immune systems are more powerful–the more severe symptoms are due to an overly strong inflammatory response. 

Practical Tips to Keep You Healthy

So, you can see why knowing more about how the immune system operates while you’re pregnant can be important information. Researchers are still looking into exactly what happens when–and to a certain extent, much of this information is interesting… but mom’s-to-be are wanting to know about practical steps they can take.

Whether you’re pregnant or not (but especially if you’re pregnant) it’s important to do all you can to keep your immune system functioning optimally. There are a couple of ways you can do this:

  • Make sure you’re getting plenty of sleep: There’s nothing quite like a good night’s sleep–especially when it comes to keeping illness away. Lack of sleep can compromise your immune system. True, getting a solid eight hours of sleep isn’t always possible when you’re pregnant. But prioritizing rest, relaxation, and recovery can help keep your immune system in good shape.
  • Eat a balanced and healthy diet: Your immune system requires an assortment of vitamins and minerals in order to function properly. The best way to get those vitamins and minerals (especially when you’re pregnant) is from your food! Generally, this means making sure to eat lots of fruits and vegetables. If you aren’t getting enough vitamins and minerals from your food, talk to your OBGYN about vitamin supplements.
  • Take prenatal vitamins: Your OBGYN will likely prescribe a course of prenatal vitamins for you to take during your pregnancy. These vitamins are specifically calibrated to promote the health of pregnant women (and their babies). In the same way, these prenatal vitamins can help keep your immune system working properly.
  • Hydrate, hydrate, hydrate: Though it may come as no surprise, it’s important to remember that hydration is fundamental to a healthy body. When you drink plenty of water, it’s easier for your immune response to detect and address infections, disease, and injury. Chronic dehydration can make everything just a little bit more challenging and lead to immune system breakdowns.
  • Exercise: Exercise is famous for improving your mood–but it will also improve your immune response. Remember that the goal of the exercise here is just to get your body moving; not necessarily to become more fit and certainly not to lose weight (unless directed to do so by your physician). A few minutes of walking here and there can help keep your body in balance–immune system included.
  • Immunizations: Consider receiving the immunizations recommended during pregnancy as advised by your OBGYN.  

It should be noted that your body’s immune system will take some time to return to normal after the birth of your baby. In other words, the roller coaster doesn’t end with delivery! Your OBGYN may monitor your hormone levels and blood work to make sure everything gets back to where it should be.

What Should You Do If You Become Ill While Pregnant?

If your immune system isn’t working the way it typically does, your next question will probably be somewhat straightforward: what happens when you get sick?

All of the above steps are intended to keep your immune system running as smoothly as possible (and in that way, keep you from becoming too ill too often). However, in some cases, getting sick is virtually unpreventable. For the vast majority of those illnesses, your immune system will do just fine when it comes to preventing serious complications.

However, there are some diseases of which you should practice heightened awareness. Those may include:

  • Covid-19: Most studies seem to indicate that pregnant individuals are at a heightened risk for serious illness and death from Covid-19 than the general population. While these risks are still low in an absolute sense, we still recommend that all pregnant people update their vaccination status as recommended by the CDC.
  • Influenza: The flu is common, but is a virus that can lead to serious illness especially if you’re pregnant. Talk to your OBGYN or Midwife about whether you should get a flu shot. If you suspect you have the flu, talk to your OBGYN or Midwife about possible treatments, including antivirals as well as safe medications to help with symptom relief.
  • Respiratory illness: Many respiratory infections, such as pneumonia, have a tendency to be more serious in pregnant people than in the general population. If you develop a respiratory illness, it’s important to inform to your OBGYN or Midwife as soon as possible.

Most pregnant individuals do not have cause to be overly worried about getting sick. However, if you do become ill, it’s a good idea to check in with your OBGYN or Midwife to discuss how best to monitor your symptoms and when to receive more urgent care.

What About Non-Normal Immune Responses?

There are a couple of reasons you may want to talk to your OBGYN about your immune system while you’re pregnant. Everyone’s pregnancy immune system, after all, will very much depend on how your typical immune system behaves. So you should talk to your OBGYN if you:

  • Have a history of a weakened or abnormal immune response.
  • Have trouble keeping your immune responses in a healthy range during pregnancy.
  • Your body does not absorb vitamins and minerals normally.
  • Exhibit a known history or current diagnosis of an autoimmune disease. 

Each of these conditions can complicate your immune response while you’re pregnant. But speaking with an OBGYN can help you plan for those challenges and develop workable and practical solutions. 

When you get sick, your baby gets sick, too. So, in a very real way, your immune system is protecting both you and your baby. Your OBGYN’s goal will be to get your immune response–all those white blood cells–working as normally as possible. 

When Does Your Immune System Go Back to Normal?

All of these changes are great–they protect you and they protect your baby. But like many changes associated with pregnancy, you always have one eye on when your body might return to its pre-pregnancy state. Even though it probably does not substantially impact your day-to-day living, you want to know when your immune system will go back to normal.

Everybody’s different, but in general it takes about six months for all of your hormone levels to start returning to normal. That means your immune system could feel a little off for at least half a year, especially if you’re body-feeding. Over time, however, your immune system will typically return to something resembling its original state.

Of course, your baby’s immune system is also just beginning to develop right after birth. So be sure to talk to your OBGYN or Midwife about how best to take care of your health after you give birth. 

Keeping an Eye on Your Immune System

Researchers and doctors are still developing diagnostic criteria to make it easier to detect normal and abnormal immune responses. What’s important for most mothers, however, is that you get your sleep, take your vitamins and minerals, and stay active–keeping your immune system as healthy as possible. 

If you have questions about your immune system during pregnancy, contact our Wilmette or Glenview offices to make an appointment!

 

Labor Induction

Sometimes, babies have a mind of their own. That’s true even when it comes to delivery. 

That’s probably why something like 25% of all babies delivered in the United States are induced. Labor induction involves speeding up the delivery process by stimulating uterine contractions before they begin naturally. Typically, labor is induced to increase the chances of a successful vaginal delivery.

Generally labor induction is safe. In some cases, however, inducing may raise the risk of certain complications. And while it’s possible to induce under elective circumstances, your OBGYN or Midwife will usually not recommend this procedure unless it is medically warranted. The vast majority of inductions are performed under very specific conditions, resulting in a successful birth and a healthy baby!

What are Some Strategies/Methods for Labor Induction?

The strategies and methods used to induce labor will depend on several factors, including how ready your cervix appears, your OBGYN or Midwife’s recommendation, and your preferences. If your cervix is not soft and ready for labor, your OBGYN or Midwife will use a two stage approach:

  • First, your OBGYN or Midwife will use methods designed to help the cervix prepare for labor.
  • Second, once the cervix is soft and ready, your OBGYN or Midwife will focus on methods that induce uterine contractions.

If your cervix is already soft and prepared for labor, then your OBGYN or Midwife will likely skip to the second step and focus on inducing contractions.

Techniques for Preparing the Cervix for Labor

  • Membrane stripping: This technique involves separating the amniotic sac from the uterine wall. Such a separation is conducted manually (your OBGYN or Midwife would gently perform this procedure). Once the amniotic sac is separated, your body may begin releasing hormones that encourage the cervix to soften and prepare for labor. Usually, labor does not begin immediately, nor is the bag of water typically broken. You may experience some cramping and light vaginal bleeding due to the procedure.
  • Cervical ripening with catheter/balloon: This technique uses a mechanical dilation process, during which a small balloon connected to a catheter is inserted into your cervix. The catheter is used to fill the balloon with sterile fluid, which puts pressure on your cervix. This pressure encourages your cervix to open–at which point, the balloon either falls out or is removed.
  • Prostaglandins: Mechanical dilation and membrane stripping rely on providing your body with physical cues that then encourage certain hormonal releases. In some cases, your OBGYN will opt to rely on hormones more directly. In these situations, a hormone called prostaglandin will be used to open the cervix. This can help prepare your cervix and often can even make the labor process shorter. However, this particular method is not recommended for women who are attempting vaginal birth after C-section (VBAC), as it could increase the risk of a uterine rupture.

Techniques for Inducing Contractions

  • Membrane rupture: Also known as breaking your bag of waters, this strategy is an option for women who have already given birth once before. When the bag of waters is broken, the amniotic fluids that compose the “waters” may soften the cervix and cause contractions that begin labor.
  • Pitocin:  Pitocin can be used to directly start contractions. Usually, Pitocin treatments begin with small doses of the medication, gradually increasing until labor begins. Pitocin is administered via an IV drip, so you’ll be closely monitored by your Midwife or OBGYN during this time. 

It can be difficult to predict how long an induction may take. Going from your first contraction to holding your baby in your arms could take anywhere between a few hours to a few days. As long as you and your baby remain healthy during the process, your OBGYN or Midwife will monitor your progress patiently.

Labor induction is usually performed either in a hospital or birthing center, but sometimes you’ll be sent home to wait for labor to begin. 

Home Remedies for Induction

Many patients are already familiar with some “home remedies” which popular culture suggests can successfully induce labor. Everything from sexual intercourse to a vigorous walk to drinking a bit of castor oil may help you go into labor.

While few of these home remedies will cause active harm, it’s worth noting that there is no evidence that most such home remedies actually work. The exception is nipple stimulation, which has been shown in research to help successfully encourage your uterus to contract and get you ready for labor.

If you’re thinking about labor induction, you should definitely talk to your OBGYN or Midwife about options that work.

When Is Labor Usually Induced?

Inducing labor is not something that should be undertaken lightly. Your OBGYN or Midwife will factor in your current health, the health of your baby, and the risks involved when deciding whether to recommend induction. In general, however, labor is most commonly induced for the following reasons:

  • You’re coming up on two weeks past your delivery date. If labor hasn’t started naturally, your OBGYN or Midwife may consider inducing labor.
  • Risks to your health or to your baby’s health crop up near the delivery date. These risks could include everything from high blood pressure and gestational diabetes to placental abruption or an infection of the uterus. Your OBGYN or Midwife will know which particular possible complications can best be addressed by inducing labor.
  • There are abnormalities with your baby. This is especially true if there are anomalies with the heart rate of your baby. Likewise, if your baby is not growing at the rate they should be, your OBGYN or Midwife may recommend inducing.
  • Labor does not begin after your water breaks. That’s because your bag of water helps protect you and your baby from infections. So if your water breaks and contractions do not begin, your OBGYN or Midwife may recommend inducing labor to help minimize the chances of an infection setting in.

This list is not comprehensive. Your OBGYN or Midwife may have other medical reasons for recommending an induction on a case by case basis.

In some cases, induction may be considered for non-medical reasons. For example, if you live far away from a hospital, you may wish to induce at a planned time rather than risk a hasty drive to the emergency room.

These types of decisions should be made on a case-by-case basis, and only after taking the time to weigh risks and benefits. That’s because inducing labor does pose risks–so most OBGYNs and Midwives will seek to avoid doing so unless it is medically necessary.

When to Avoid Inducing

If everything is progressing normally, your OBGYN or Midwife will want to avoid labor induction, letting your baby and your body set the schedule. However, there are some instances when your OBGYN or Midwife may avoid inducing labor even if other indications would normally suggest that it’s the best course of action.

Your OBGYN or Midwife will avoid labor induction if:

  • Your baby is not positioned properly. If your baby is not oriented with its head down, towards your pelvis, then they likely are not ready to be delivered vaginally. If your baby is sideways or feet first, your OBGYN or Midwife will not induce labor.
  • The cervix is being covered by the placenta. 
  • You had previously undergone a C-Section, and that C-Section required major surgery or a specific type of incision. 
  • You experience umbilical cord prolapse. This occurs when the umbilical cord slips into your vagina before delivery.

Are There Risks Involved with Inducing?

For many women, there are some risks involved with inducing labor. Your OBGYN or Midwife will help you evaluate those risks, especially in relation to potential benefits. If induction is performed before the 39th week, your baby could experience health complications. 

For example, one risk with employing Pitocin is that your contractions may begin to happen too frequently, and this can lower your baby’s heart rate. For this reason, you’ll wear a fetal heart rate monitor so your OBGYN or Midwife can monitor your baby’s safety. 

Induction may increase your chances of needing a C-Section, but this depends on a variety of other risk factors, so it’s best to talk to your OBGYN or Midwife about the pros and cons.

Talk About Labor Induction

If you have questions about when labor is induced (and when it isn’t), the best place to get individualized answers is from your OBGYN or Midwife. While it might sound like an unwanted outcome at first glance, inducing labor can be a great way to increase your chance for a successful vaginal delivery. Sometimes your baby just needs a little encouragement to say hello to the wider world!

Our midwives track their patients’ induction rates. If you’d like to learn more about those rates or have questions, please contact us at our Wilmette or Glenview offices!

 

Getting Pregnant After 35

There are incredible advantages to getting pregnant after 35. New parents entering their late thirties are often more economically and socially stable. And you may be more prepared–emotionally and physically–for the responsibilities and joys of parenthood. There’s even some evidence to suggest that growing your family after you reach 35 can make you a better parent. So it’s no surprise that more and more women are holding off on having children until they feel ready.

As with any pregnancy, however, there are some unique challenges that you might encounter if you become pregnant in your late thirties. Knowing the challenges you may encounter on your journey can help you prepare and give you time to focus instead on the joys of motherhood.

How Common is it to Get Pregnant After 35?

In 2014, the mean age of women in the U.S. who gave birth to their first child was 26.3 years old. That was up from 24.9 years in the year 2000. The statistics generally indicate that it’s more common for mothers to give birth to their first child in their twenties than in their thirties or forties. But that’s not the whole story.

According to data gathered by the Centers for Disease Control and Prevention, the number of mothers who get pregnant after 35 increased from 7.4% in 2000 to 9.1% in 2014. That may not seem like a huge jump, but it does convey an unsurprising trend: giving birth over the age of 35 is becoming safer, more successful, and more common.

Options To Improve Your Chances of Conceiving

Getting pregnant after 35 naturally might seem like a challenge at first. An average woman over 40 has a roughly 5% chance per cycle of becoming pregnant, compared to a 25% per cycle chance for women in their 20s. At 35, your chances will usually fall somewhere between the two. For most couples, doubts about success often give way to the joys of success rather quickly.

That said, if you are finding it difficult to successfully conceive, there are several options that can help you improve your chances. And that’s true no matter the age at which you decide to expand your family! Some of the most popular such options include:

  • Hormones: In some cases, you may be prescribed certain hormone drugs that help increase egg production. This often increases your chances of getting pregnant.
  • IVF: In-vitro fertilization (or IVF, as it is more commonly known) is a fairly common fertility treatment. Using this technique, a medical professional will fertilize the egg outside of the body. Once fertilization is successful, the egg is then implanted into the womb, drastically improving chances of conception.
  • Egg preservation: In some cases, women who delay becoming pregnant will decide to have their eggs frozen. Using younger, preserved eggs may sometimes have advantages and lead to more successful fertilization.
  • Male fertility treatments: Since women over 35 often have partners around the same age range, challenges with getting pregnant sometimes stem from aging sperm. Male fertility treatments can help make sperm more effective and, therefore, increase the chances of successful fertilization.

Getting pregnant after 35 naturally may be your preference. So whether any of these options are right for you will depend on your unique situation and goals.

What to Think About When Getting Pregnant After 35

For all the benefits–for both you and your children–that come with becoming pregnant after the age of 35, there are some risks that you should be aware of as well. Any risks related to pregnancy and childbirth will vary considerably from person to person, so it’s important to talk over all of your concerns with your OBGYN or Midwife. The vast majority of risks can be minimized with the right planning.

Pregnancy After 35 Risk Factors

Some of the more pronounced pregnancy after 35 risk factors include:

  • You’re more likely to develop certain health complications, such as gestational diabetes and high blood pressure. A healthy lifestyle helps reduce the risk of these complications, but additional medical treatment is required if they arise.
  • Risks of miscarriage or stillbirth are elevated over the average population in women over 35.
  • There is a higher likelihood for delivery via a Cesarean section. This is a contingency you should discuss with your Midwife or OBGYN.
  • Chances of a premature delivery (prior to 37 weeks of gestation) are increased, above the average population.
  • It may simply take you some extra time to successfully become pregnant.

These risks might sound alarming, but it’s important to remember that most pregnancies–in women above 35 and below–result in an uncomplicated, normal birth. Being aware of risks often helps you minimize their statistical likelihood. When you work with your OBGYN or Midwife to be proactive about your healthy pregnancy, you can spend less time worrying and more time focusing on the joys of pregnancy and motherhood.

Common Considerations

Any pregnancy will require some special considerations and post-35 pregnancies are no exception. Some of those special considerations may include the following:

  • Screening: There are some genetic, chromosomal tests that can help identify certain abnormalities. If you’re interested in a DNA screening, you should definitely talk to your OBGYN or Midwife, as some of these testing methods do carry a slight risk of miscarriage.
  • Stay active and eat well: This advice might sound universal–every medical professional wants you to live a healthy lifestyle. But for women over 35 who want to become pregnant, this advice can help increase your chances of an uncomplicated delivery.
  • Take prenatal care seriously: From taking prenatal vitamin supplements to making regular appointments with your OBGYN or Midwife, participating in routine prenatal care is shown to improve outcomes in pregnancy.
  • Get the facts before you start: Many OBGYNs and Midwives will recommend what’s been nicknamed a “preconception” appointment for women over 35 who wish to have children. These appointments are designed to help you receive personalized advice that can help you safely achieve your pregnancy goals.

Is Delivery Different if You’re Over 35?

The vast majority of births in women over 35 are uncomplicated vaginal deliveries. Child birth for women over 35 does carry slightly higher risks of complications, and as such, cesarean section deliveries are somewhat more common among this age group.

Pregnancy: Over 35 vs Under 35

The broad strokes of most pregnancies–whether in women over 35 or under 35–will be generally similar. You’ll likely be pregnant for 9-10 months, experience morning sickness for the first trimester, and be somewhat tired and uncomfortable during your final trimester. However, there are important differences for women over 35 in terms of how their pregnancies might proceed.

Some of those differences include:

  • More prenatal testing: Because certain birth defects are more common in mothers over the age of 35, your OBGYN or Midwife will want to run a number of additional blood tests and genetic diagnostics to screen for common defects. You’ll talk to your OBGYN or Midwife about the information genetic screening can yield–as well as how to handle possible results.
  • Additional diabetes screenings: Because both gestational and non-gestational diabetes are more common in women over 35, your OBGYN or Midwife may want to run additional tests throughout your pregnancy to ensure any diabetes you may develop is detected early.
  • Your birth plan may have more contingencies: The vast majority of pregnancies in women over 35 are delivered vaginally. However, women over 35 are more likely to require a C-Section delivery. As a result, your birth plan may touch on these contingencies in more detail than if you were under 35. 
  • You might take more vitamins: Women over the age of 35 tend to need a little extra help staying healthy during pregnancy–especially when it comes to getting enough vitamins and minerals. That’s why your OBGYN or Midwife might suggest you take more prenatal vitamins than is typical for patients under 35. 
  • There may be a higher chance of complications: And because there’s a higher chance of complications, you might have more checkups, more appointments, and generally have to pay closer attention to certain things. For women who become pregnant over the age of 35, it’s likely you’ll have more contact with your OBGYN or Midwife than those who are under 35.
  • You may have better health insurance: There are also advantages to getting pregnant over 35–and one of those is that you may have better access to a variety of resources! This could include family and friends, but it could also extend to financial resources. 
  • You might have more familiarity with your physician and medical preferences: Many women over the age of 35 have been going to the same OBGYN or Midwife for years. That means you may already have some familiarity with your care team when you become pregnant. By the same token, you’ll likely be more familiar with your own medical preferences at 35 than you might be at 25.
  • Risk assessments: If there are complications, your body may have a harder time bouncing back from them. As a result, your OBGYN or Midwife might evaluate risks differently when you’re 35 than when you’re 25. 

There are also some non-medical ways in which delivery may be different if you’re over 35. For example:

You may have a well-established career, and therefore have access to better healthcare benefits. For example, you may be able to take longer maternity leave when you wait until your late thirties to grow your family. Better medical insurance (and more financial power) also means you may have more healthcare options, ensuring access to the type of delivery you want.

Many women in their late thirties have a strong support system, so you’ll have less to worry about during your delivery. This also means you’re more likely to be able to enjoy those precious first moments of bonding with your newborn.

More Common and More Successful

There’s no universally “right” time to have children or expand your family. For women over 35, pregnancy and motherhood can be especially exciting.

Our OBGYNs and Midwives at both our Wilmette or Glenview offices have successfully helped many new mothers over thirty-five. You can learn more about our obstetrics services here. If you have questions or want to schedule a preconception consultation, contact us today to get started!

C-Section, VBAC, Operative Vaginal Delivery, Singleton Vertex C-Section, Oh My

No two deliveries are quite the same. Your body, your baby, and your OBGYN or Midwife all have their own influence (some more pronounced than others), making each delivery almost entirely unique. While deliveries are often portrayed rather similarly in popular media, the reality is that there are many medical techniques which may be used to assist with or supplant routine delivery. 

 

Which delivery option is right for you will depend on your health, your baby’s health, and any possible complications that may arise. As a result, your optimal delivery mode may change from moment to moment. A routine delivery may suddenly become a C-Section or Operative Vaginal Delivery due to your immediate medical needs.

What Does it All Mean?

When you’re pregnant, you hear no shortage of acronyms and jargon! So, it’s nice to have a quick definition of what all of these mean:

  • C-Section: During a Cesarean Section, the baby is delivered via a surgical incision made in the abdomen and uterus. 
  • Singleton Vertex C-Section: This is a C-Section performed on a single baby (not twins, triplets, or more) whose head is pointed down, towards the birth canal. In other words, Singleton Vertex C-Sections tend to be those which are either less predictable or elective.
  • Operative vaginal delivery: When your OBGYN or Midwife uses forceps, a special vacuum or other tools, it’s usually referred to as operative vaginal delivery.
  • VBAC: Also known as Vaginal Birth After C-Section, this is exactly what it sounds like. A woman who is giving birth vaginally after having given birth via C-Section in the past.
  • TOLAC: Trial of Labor After C-Section is when a birthing person attempts to have vaginal birth after C-Section or VBAC. If unsuccessful, a Repeat C-Section (RCS) will be performed. 

C-Sections

A C-Section is a surgical procedure in which an incision is made along the abdomen and through the uterus. The baby is then delivered via this incision. Some women elect to deliver via C-Section as a matter of preference. For most, however, a C-Section is used due to complications or risk factors that arise during pregnancy or labor.

In general, C-Sections are performed under regional anesthesia–which means you won’t be able to feel anything from the waist down. Recovery from the procedure usually means 3 days or so in the hospital–and then several weeks of rest and recuperation once home. 

A C-Section may be performed for a wide variety of reasons, including the following:

  • The baby is not in the correct birthing position (the head is not pointing towards the birth canal).
  • The baby may be in apparent distress.
  • The mother may be giving birth to multiple babies (such as twins, triplets, or more)
  • The mother may have previously given birth via C-Section

This list is not exhaustive, but it does represent some of the more common reasons for undergoing a C-Section.

What is a Singleton Vertex C-Section?

A Singleton Vertex C-Section is a Cesarean Birth in which there is a single baby being delivered and that baby’s head is in the downward facing position. Singleton Vertex C-Sections are closely tracked by medical professionals because they are often elective. This can provide medical professionals with a good data set to compare the health and safety of C-Sections and vaginal births.

On an individual basis, however, a Singleton Vertex C-Section may be performed for a wide variety of reasons, some of which are elective and some of which are in response to complications. 

So don’t let the jargon throw you for a loop! Many C-Sections are Singleton Vertex C-Sections. The nomenclature is simply a way of designating how many babies are being delivered (1) and what position that baby is in (head facing the birth canal). 

Operative Vaginal Delivery

During an operative vaginal delivery, an OBGYNwill use either forceps, vacuum extraction, or a combination of both in order to assist with the delivery. 

Operative vaginal delivery methods are usually deployed only when problems or complications arise during labor–usually during the second stage. As a result, operative vaginal delivery is not something expectant mothers can elect to undergo (as they could with a C-Section, for example) and must be performed by a trained provider like OBGYN. Still, the possibility that these methods may be used is a good reason to discuss the procedure with your OBGYN or Midwife. 

When is Operative Vaginal Delivery Used?

Operative Vaginal Delivery is an interventional approach designed to assist with birth when problems develop. Your OBGYN or Midwife will use either forceps or vacuum extraction (or a combination of both) depending on a variety of factors. Using these tools, your OBGYN will attempt to gently coax your baby through the birth canal.

An operative vaginal delivery is usually deployed when:

  • The progress of the delivery stalls even when labor continues (and the mother continues to actively push). 
  • There’s an indication that the baby is in distress.

Operative vaginal deliveries account for something like 3% of all births. So they aren’t exactly common, but they do happen. 

TOLAC and VBAC

TOLAC stands for Trial of Labor After C-Section. A successful TOLAC will result in Vaginal Birth After Cesarean (VBAC).

After a woman has a C-Section delivery, certain complications may crop up which could make vaginal delivery more challenging. TOLAC is designed to help women deliver again without the need for a C-Section. 90% of women who have had a C-Section are candidates to deliver vaginally. But VBAC isn’t for everyone. Your OBGYN or Midwife will have a consultation with you to discuss the risks vs benefits to make sure you’re healthy enough for a vaginal delivery after a C-Section.

You may not be a good fit for a VBAC if you:

  • Have delivered via C-Section multiple times.
  • You have a prior vertical incision along your uterus.
  • Your C-Section scar has broken open on previous occasions.
  • You have undergone certain other surgical procedures (such as fibroid removal).

However, everyone’s body is different, so your OBGYN or Midwife will carefully review your history and provide counseling on your risks vs benefits. VBAC is generally done because it provides some significant benefits. Those benefits include:

  • Lower risk of complications, such as infection, excessive bleeding, or blood clots.
  • A shorter hospital stay and recovery time after your delivery. 
  • More options for future deliveries. Most women who have two C-Sections in a row are not able to safely select VBAC as an option. This also means you’ll have more of an ability to individualize your birth plan.

The best candidates for VBAC are generally women who have delivered vaginally in the past. 

Choosing the Right Delivery Option for You

When you work with an OBGYN or Midwife, you’ll have the option to create a birth plan that best suits your healthcare needs and your desires. Sometimes, a C-Section or VBAC approach is part of that plan.

In other cases, a C-Section or Operative Vaginal Delivery may occur because complications present during labor. The more you know about these approaches beforehand, the fewer questions you may have at the moment, so be sure to talk to your OBGYN or Midwife about all of the possibilities.

Our providers track their patients’ birth rates via each of these methods. If you’d like to learn more about those rates or have questions, please contact us at our Glenview or Wilmette locations.

 

An Introduction to C-Sections

Most people would be surprised to learn that nearly 30% of all children in the United States are delivered by C-Sections. A surgical method of giving birth, a C-Section–or Cesarean Section (sometimes called a Cesarean Birth) –involves making an incision along the abdomen and through the uterus. The baby is then delivered via this incision rather than vaginally.

For some women, a C-Section is planned out in advance. For others, this surgical technique is used as an urgent alternative due to complications with vaginal birth.

What Happens During a C-Section?

C-Section deliveries most often occur under regional anesthesia (meaning you won’t feel anything from the waist down). Depending on your situation, the anesthesiologist may employ a spinal block or epidural to help control pain and discomfort.

During a C-Section, your surgeon will make an incision through the abdomen and uterus. 

On rare occasions, a vertical incision, also known as a classical cesarean section, may be used. More commonly, however, your physician will employ a horizontal incision, also known as a low transverse cesarean section (LTCS). Once the incision is made, the baby will be delivered. Then the wound will be cleaned and closed.

Whether you are planning on delivering via Cesearean or simply want to be prepared for the possibility, you can talk over your options with your OBGYN or Midwife to make sure your preferences are documented in your birth plan. 

How Does a C-Section Compare to Vaginal Birth?

Whether your baby is delivered vaginally or via C-Section, recovery and healing will take time.

With a vaginal delivery, you will likely be discharged from the hospital more quickly (assuming there are no complications). While recovery from a C-Section may initially last a bit longer, there is some evidence to suggest that those who undergo a C-Section may be less prone to certain long-term complications, such as urinary incontinence and pelvic organ prolapse.

Vaginal deliveries are generally considered to be the least invasive and lowest risk birthing option. But there are cases in which specific risk factors may make a C-Section a safer approach, so make sure to talk to your OBGYN or Midwife about what your optimum birthing plan looks like.

 

When Should You Get a C-Section?

There are some situations, however, in which a C-Section will unquestionably be the safest and best way to deliver your baby. Often, these may be emergency situations in which a C-Section will save both the life of the mother and of the baby. In other instances, a C-Section delivery may limit the possible occurrence of dangerous complications.

Your OBGYN or Midwife may recommend a C-Section if:

  • Your labor stops progressing: The most common reason for a C-Section delivery is stalled labor. This occurs when the cervix does not open sufficiently even when adequate contractions have been occurring for hours. In these cases, C-Sections are often the safest way to deliver your baby.
  • You have had a previous C-Sections: Many women are able to attempt having a Trial of Labor After C-Sections (TOLAC) and are hopeful for a successful vaginal birth after a C-Section (or VBAC), but for some the risks may outweigh the benefits. Once you undergo a C-Section, it may be more challenging to have a vaginal birth.
  • You have a heart or brain condition or other health concerns: If you have significant health concerns, your OBGYN or Midwife may recommend C-Sections.
  • You have an emergency situation: There are some situations in which an emergency C-Section is needed to safely deliver a baby. For example, a C-Section will need to be performed quickly if your baby’s heartbeat indicates fetal distress. Similarly, if medical staff notice other emergency indications, such as a prolapsed umbilical cord or a mechanical obstruction of the birth canal, your OBGYN or Midwife may perform a C-Section delivery.
  • You are delivering multiple babies: Delivering more than one child can significantly increase the risks of complications. So if you’re expecting more than one baby, your OBGYN or Midwife may decide that it’s safer to plan on a C-Section delivery. This is especially true if you’re giving birth to triplets (or more) or your twins are not in the optimum birthing position.
  • Your baby isn’t in the right position: A healthy vaginal delivery depends on your baby being in the right position. If your baby is not in the right position when delivery begins, your OBGYN or Midwife may use a C-Section for delivery in order to avoid possible complications.

As with vaginal delivery, there are some risks associated with a C-Section delivery. Those risks include the possibility of infection or blood clots, as well as negative reactions to anesthesia or postpartum hemorrhaging. These complications are relatively uncommon, but it’s important that you discuss these possibilities with your OBGYN or Midwife before proceeding.

For most women, there is a possibility that a C-Section may increase certain risks and hazards associated with subsequent pregnancies. Your OBGYN or Midwife will be able to discuss your future VBAC options with you.

Does a C-Section Mean You Cannot Have a Vaginal Delivery in the Future?

Many women who undergo C-Sections will present increased risks of complications in future pregnancies. For that reason, your OBGYN or Midwife will want to evaluate the safety of a vaginal delivery after C-Section surgery (VBAC). 

This does not mean that a C-Section will strictly rule out the possibility of a future vaginal delivery. In fact, many women do go on to deliver vaginally after having had a C-Section in the past. But your OBGYN or Midwife will likely want to be more careful in their approach and have a consultation to review your operative report and discuss risks, benefits of both modes of delivery

What is C-Section Recovery Like?

It usually takes most people six weeks or so to fully recover from their C-Section delivery. While everyone heals at a different rate, your recovery may generally look something like this:

  • Days 1-3: You’ll likely spend the first few days in the hospital recovering from the surgical procedure. It may take several hours for anesthesia to wear off, but usually you’ll be able to breastfeed as soon as you feel up to it. 
  • Weeks 1-2: For the first couple of weeks after the procedure, you’ll want to rest where and when you can. Most women will be advised to avoid picking up heavy objects or engaging in activities such as driving. You’ll be able to talk to your OBGYN or Midwife about pain management options.
  • Weeks 3-6: You’ll check in with your OBGYN or Midwife to ensure that your incision is healing properly and without infection. Continue to address pain using medication (most of which are safe for breastfeeding purposes–but you can still check with your OBGYN or Midwife if you have concerns).

You’ll want to avoid sexual intercourse for six weeks after your C-Section delivery in order to prevent the possibility of infection and unplanned pregnancy. And you should contact your healthcare provider immediately if you are feeling depressed or feel like you may be suffering from postpartum depression.

Get Your C-Section Answers

A C-Section is a relatively common surgical procedure in the obstetric world, but it’s still very reasonable to have questions about what happens before, during, and after delivery. The team of OBGYNs and Midwives at NSAGO are here to answer your C-Section questions. Our providers track their patients’ C-section and VBAC rates If you’d like to learn more or have questions, please contact us in Wilmette or Glenview today!

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