Why not just do a Cesarean Section?
Posted On: October 09, 2012
Often, patients ask "why not just do a cesarian section?". When a patient is in labor and they are frightened, it often seems like the quick way to have the baby and not have to worry about pain. This is not a good time to be asking about a cesarian section.
While you are pregnant and feeling well and happy, you are in a better frame of mind to understand the controversial issues that are being discussed today.
Fear of pain is the biggest factor in a women's asking for a cesarian section. The reality is, epidural anesthesia, widely used today, will give excellent pain relief. Once you are comfortable, you will be in a better frame of mind to let your body labor naturally. It is also important to remember that after the operation, you will have pain. Recovery from a cesarean section is not as easy as a vaginal birth.
Most families will have more than one child. To have a surgical procedure with each child is not easy on the mother or the family. In general, after the first vaginal birth, the others come much easier. On the contrary, multiple cesarean sections pose increasing risks for the mother. Due to scar tissue formation, damage of the bladder and bowel become more common. The placenta may become adherent to the uterus, leading to excess blood loss and the need for a hysterectomy.
Recently, there has been some discussion about elective cesarean section to prevent damage to the pelvic floor which can result in urinary incontinence. This is still very controversial. It is well known that women who have never labored and had primary cesareans for other reasons may also have urinary leakage later on in life. There are also women who were never pregnant that developed these problems. Therefore, it is not safe to assume that an elective cesarean section will prevent incontinence. Again, mutiple cesarean births lead to increasing risk of organ injury, hemorrhage and hysterectomy.
Vaginal delivery is still the safest delivery method.
Denise E. Lester MD
Unwanted leakage of urine in women is a very common problem. It is also a source of great embarrassment and therefore, often not revealed to the doctor unless specifically asked. Older women often think it is a normal part of aging and others may think there is nothing they can do about it. Still other women think that only surgery will help and they are either too old, not interested or have knowledge of others in whom surgery was unsuccessful. It is important to understand that incontinence is not a normal part of aging, that there are a variety of types of incontinence and that surgery is only one of the treatment options.
In younger, child-bearing age women, leakage of urine with coughing or exercising, commonly called stress incontinence, is the most common type of urine leakage. In the case that the quantity is not great and there is strong motivation pelvic floor muscle rehabilitation can provide significant improvement. We know that aging causes muscle weakness and the slight loss of urine may become a large loss with the advancing years. Pelvic floor rehabilitation after childbirth or pelvic surgery may help prevent leakage of urine by maintaining good muscle control.
If biofeedback therapy is not helpful or the condition is more advanced, surgery is 90% successful in the correction of stress incontinence. The good news about surgical repairs today is that they can be done usually on an ambulatory basis with a quicker recovery than in the past. Today, a small incision is made in the vagina and a sling is passed to help support the urethra from moving up and down with coughing or exercising. The sling acts like a hammock to support the urethra and prevent urine leakage. 100% dryness cannot be guaranteed but the vast majority of women are satisified with their results and report an improvement in their quality of life.
Urge incontinence is more common as women age. It is a sudden loss of control with a strong desire to urinate usually resulting in the loss of larger quantities of urine. Medical therapy is usually the first line of treatment although biofeedback has also been shown to be as effective in highly motivated persons. Medication will not help everyone and may have unpleasant side-effects such as dry mouth and constipation. In the case that urgency incontinence cannot be alleviated with medical therapy, Interstim or neuromodulation may be tried. Instead of working on the bladder muscle like the medication does, neuromodulation works on the nerves that go to the bladder. A nerve test is performed either in the office with local anesthesia or outpatient to see if the symptoms are improved. After a trial period of a few days, if the symptoms are at least 50% better, a permanent lead is placed with a battery that will last 5 years. It is totally reversible and the battery can be replaced as an outpatient procedure.
Interstim has also been used for people with urgency, frequency, interstitial cystitis and incontinence of stool due to irritable bowl syndrome. It has been used to treat over 50,000 people worldwide since 1994. Now because of a simplified approach it can be done on an ambulatory basis.
Not all urinary problems need medication, surgery or biofeedback exercises. Somtimes attention to diet with the reduction of caffeine and more regular drinking and voiding patterns may help to reduce the problem. The important thing is to discuss it with your health care provider who will be sensitive to your problem and be able to direct you where to get the help that you need. Urinary and fecal incontinence is a special field of interest and there are professionals who can better help identify the cause and find a suitable treatment for you.
The Myth of a Solo Practice
Many patients believe that if they are seeing a doctor in a small or solo practice, that they will have "more personal care". Good health care however, is not a personal issue. It is a medical issue.
Having a heathy baby requires nine months of care and then a long labor course with a physician attendant overseeing the labor and delivery.
The reality of solo practice is that the obstetrician cannot be there for the long hours of labor and delivery. Frequently he or she has coverage arrangements with other small, or solo, practitioners. Therefore, the likelihood of a solo or small doctor practice delivering their own patients is small.
The cesarian section rate for small and solo groups is higher because the physicians cannot afford to spend hours with one laboring patient and then see patients in their office. There is reliance on residents and nurses to oversee labor.
At South Bay, we have doctor dedicated time to care for patients in labor. Over the nine months of your pregnancy, there is ample time to get to know all of the obstetricians if you choose to do so. There is also great comfort in knowing that your obstetrician will be there when you are in labor, and that you will be given every opportunity to have the birth plan that you desire. Our doctors are not pressured to perform a cesarian section so they can get back to other patirnts in the office.
Do You Have Problems With Your Teenager?
Adolescence, or puberty is the period between 10 and 20 years of age. Children start having physical and emotional changes secondary to the hormones, progesterone and estrogen in girls, and testosterone in boys.
The transition from Childhood to Adulthood is not easy for them or for the parents. Parents have been in control of their lives, time and friends. Now, they relate to fashion, want to experiment and they spend more time with their friends than with their family.
Adolescents are exposed to tremendous amounts of information from television, Internet, radio, school and friends. They may talk about sex, pregnancy, homosexuality, smoking, alcohol and drugs. Unfortunately, it is very common that teenagers have inaccurate information.
If parents do not have a good relationship and dialogue with their children, this will be the last opportunity to get close to them. They soon will be finishing college and starting their own family.
It's very common to feel uncomfortable to start a conversation about sex, alcohol, drugs, sexually transmitted disease, and contraception. Just remember, you were in similar situations at that age, but in a different generation. It is never too late to talk to your adolescent as a friend and not as a parent.
If you do not feel confident talking about these topics, read and ask the professionals how to do it. This will show them that they are the most important part of your life and you want to help them.
Adolescence is a decisive stage in the development of the adult, with moral values, perserverance and optimism. If you can show them that life has difficult times, but they can always come to you for information, advice and comfort, they will not get lost in alcohol or drugs, or people that will take advantage of their emptiness.
Halo Breast PAP is Here!
Did you know that 70% of women who get breast cancer have no family history or other risk factors for the disease?
Did you know that breast cancer is the leading cause of cancer death in women aged 20-59?
South Bay OB/GYN is proud to announce that we are offering a new test that can detect pre-cancerous changes in the breat 7-10 years before the cancer may be visible on a mammogram. The HALO Breast Pap Test detects abnormal cells in the milk ducts where 95% of all breast cancers originate.
The HALO Pap Test takes 5 minutes, is not painful, and is recommended for all women aged 25-55. A breast pump type device is applied to extract fluid which will then be analyzed like a pap smear of the cervix. If atypical cells are found the breast cancer risk is increased 5 times. If no fluid or atypical cells are produced the woman is at low risk.
This is an annual test which is not to replace the regular annual mammography.
If you are interested, please ask your doctor if you are a candidate for this test and schedule the appointment or ask for additional information.
In Office Permananet Sterilization
The Essure procedure is the first and only FDA approved permanent birth control procedure to have zero pregnancies in the clincal trails.
What is the Essure procedure?
Essure is different than the traditional method of a surgical tubal ligation. With Essure, there is no cutting or burning of the body. Instead, an Essure trained doctor inserts, through the body's natural pathways (vagina, cervix and uterus) and into your fallopian tubes.
During the first 3 months following the procedure, your body and the micro-inserts work together to form a tissue barrier that prevents sperm from resching the egg. During this time, you will need to use another form of birth control.
After 3 months, your doctor will order an Essure confirmation test, done by a radiologist it is a special type of x-ray to confirm that your tubes are completely blocked and that you can rely on the Essure micro-inserts for Birth Control.
We are performing the Essure procedure in our office under light anesthesia. For more information about Essure please make an appointment with one of our doctors or to learn more go to www.essure.com.
The Skinny on Biodentical Hormones
As many of the baby boomers are approaching the menopause there is great interest in hormone replacement therapy. Since the WHI (Women's Health Initiative) Study, women have become frightened to use estrogen and have been looking for alternatives to reduce their troubling menopausal symptoms.
Following a period when physicians would prescribe estrogen as a panacea against heart disease, osteoporosis, Alzheimer's and hot flashes, women have lost confidence in the medical establishment when the study revealed that in fact estrogen use increases the risk of breast cancer and may in fact increase the incidence of heart attack in women. When Suzanne Somer's book came out endorsing the use of "bioidentical hormones" women took notice.
Are bioidentical hormones a better, safer alternative to the prescription drugs that your doctor may offer? Bioidenticals are not "natural" hormones. In reality, compounded bioidentical hormones and FDA approved bioidentical hormones all come from the same precursors. They all begin as soy products or wild yam and then get coverted to the different hormones in a laboratory in Germany. The claim that all bioidentical hormones are engineered to become the same chemical structure as natural female sex hormones is false.
The risks associated with hormone replacement are the same for FDA approved medications as for the bioidenticals with the exception that with the compounded batch it is not known how much or what a women is receiving. They are not regulated or monitored by the FDA and are therefore lacking in tests for purity, safety, potency, and efficacy. When the FDA did analyze compounded bioidentical hormones 34% failed one or more quality tests.
Many clinicians who prescribe bioidentical hormones base the dosage on salivary hormone testing. There is no scientific evidence that a correlation exists between a patient's symptoms and salivary hormones. There are no published studies in the literature that show that salivary testing is a reliable measure on which to safely base dosing decisions. The Endocrine Society and American College of Obstetricians and Gynecologists issued statements advising against salivary testing and their lack of reliability.
In summary, bioidentical hormones cost more, the salivary testing costs more, the consultation often is more costly and no information is given to the patient regarding the risks and benefits of these hormone alternatives which are not monitored by the FDA. The additional concern is the conflict of interest when the practitioner who prescribes them is the one who is selling them. Let the buyer beware.
Labor Induction at 41 Weeks Lowers Cesarean Rate
WASHINGTON, DC -- Inducing labor at 41 weeks gestation may lower cesarean rates in pregnant women without compromising the health of their baby, finds a study in the June issue of Obstetrics & Gynecology. Researchers at the University of Florida performed a systematic review of 16 randomized controlled trials that compared labor induction and expectant management for uncomplicated, singleton pregnancies involving 6,588 women who were past their due date. They concluded that labor induction at 41 weeks significantly reduced the risk (by about 12%) of cesarean delivery, compared to that of women whose labor was not induced. The study also found that inducing labor post-term resulted in fewer infant deaths and lower rates of fetal distress.
Their analysis of fetal heart rate complications further revealed fewer cesareans with labor induction compared to deliveries without intervention. Researchers say this finding accounted for much of the overall reduction in cesarean delivery associated with labor induction.