As a certified nurse midwife for 20 years, I know that Cesarean sections are sometimes necessary, for the mother and the baby. But I also know that the C-section rate in the U.S.—nearly a third of babies are now delivered that way—is much too high. And even when C-sections are appropriate, pregnant women and their health-care providers should push for practices that reduce post-operative complications and improve the chance of a future vaginal delivery. Here are six suggestions on how to do that, from an article in the December issue of Obstetrics and Gynecology.
1. Get antibiotics in the hour before surgery. That slashes the rate of post-operative infections by as much as 50 percent compared with getting the antibiotics when the umbilical cord is clamped midway through the procedure, as is often done. And it’s especially important given the results of another study in the October issue of the American Journal of Infection Control. Researchers from the University of Texas found that most wound infections following C-sections were colonized by MRSA, a potentially fatal bacteria that is resistant to many antibiotics.
2. Prevent uterine rupture. This rare but serious complication of vaginal birth after Cesarean (VBAC) can be significantly reduced if the uterus is closed with a double layer of suturing during the initial operative delivery.
3. Prepare the skin properly. Removing hair from the surgical site with clippers rather than a razor, and scrubbing the area with the antiseptic chlorhexidine rather than povidone-iodine, makes wound infections less likely.
4. Be less invasive when delivering the placenta. Gently pulling on the umbilical cord rather than separating it from the uterus with by hand can reduce the risk of infections.
5. Prevent blood clots. Patients at risk for blood clots after delivery should be given compression stockings that rhythmically compress their legs, doses of anticoagulant medication until they are up and walking around, or both.
6. Suture extra when needed. For women with a thicker layer of fat below the skin, a second layer of suturing can help prevent the wound from opening post-operatively.
While it may seem awkward asking your obstetrician whether she or he follows those protocols, with so many women delivered operatively, you can’t afford not to. In fact, you should be wary of any provider who hesitates to answer these or any other questions you might have. So while you’re at it, ask about your provider’s current C-section rate, too. After all, the best way to avoid post-operative complications is to have a vaginal delivery whenever that’s safely possible.
—Joan Combellick, certified nurse-midwife
