Whenever faced with this question, you should differentiate between planned normal delivery from planned C-section because the risks of unplanned, emergency C-section cannot be compared to the other two categories. Naturally, all emergency surgeries carry higher risks. These risks may, in part, be due to the sudden surgery and, in part, due to the reasons for the emergency surgery. Till about a decade ago we felt that a normal delivery is better than a planned caesarean section.
However, it’s important to be scientific about this. A review of research articles on this topic conducted by NICE (National Institute of Clinical Excellence), a UK based organisation concerned with preparing scientific guidelines, says that the amount of risk of both is similar; only the type of risk is different. C-section, for example, may be associated with longer hospital stay, more expense in certain hospitals, more bleeding, more heart attacks, less likely to return early to household activities and work, less likely to start breast feeding and to continue it beyond one month, more intensive care admission for the baby, more respiratory problems including asthma in the baby on growing up. The risks of these are very low, but exist. Further, there is slightly higher risk of maternal death. The data on deep vein thrombosis, blood transfusions, wound infections, hysterectomy and anaesthetic complications is conflicting, but all are very low due to better techniques, anaesthesia medicines and antibiotics. Normal delivery may be associated with more injuries to the birth passage and the urinary tract and women with previous such problems are well advised to opt for elective C-section. Some studies also suggest that women feel more confident, self-reliant and empowered after a normal delivery and feel a sense of failure after C-section. So all C-sections, planned as well as emergency, should be scientifically justified. An important view is that more women opt for planned C-sections nowadays because horror stories of normal births have scared them. This is where a caring, warm, pleasing atmosphere combined with excellent scientific judgments can be of great help to deliver your child.
What are the advantages and disadvantages of painless delivery?
Today, we have become a society that is intolerant to pain of any kind. Rates of C-section are rising and normal delivery declining. An important contribution to rising C-section is due to patient’s demand for it. Often this is because of the astrologer but it’s mostly due to fear of pain during normal delivery. A traumatic experience because of pain scars a woman for future delivery. In such a scenario, the availability for expert pain-free deliveries comes as a boon.
There are many ways for relief of pain during labour – non-drug therapies like acupressure, meditation; morphine like drugs, ‘laughing gas’ (nitrous oxide mixtures) and epidural injection. Of these only the epidural injection provides consistent and sufficient relief from pain. It involves injection in the space outside the spinal cord in the lower back area and leaving a tubing inside which can be used to give continuous supply of low dose of drug using a pump or by intermittent injections.
The relief from pain of labour by epidural injection is excellent and can be controlled by the patient giving her a sense of involvement in her own labour process. In case there is need for an emergency C-section, a ‘top-up’ of the injection is all that is required. In fact, the patient is only slightly sedated during the surgery and is immediately available for her baby soon after it is delivered. This strengthens mother-child bonding. Problems like nausea as well as side-effects from other drugs are also much lesser than general anaesthesia. There may be slightly prolonged duration of labour and increased chances of Vacuum or forceps delivery but C-section is increased only by 4%. The patient may have some difficulty in walking without support while in labour and in passing urine but these improve with lower doses. The ‘pushing’ efforts are not much decreased. There are no problems in the baby’s heart rate and well-being. Epidural injections are used as a treatment for chronic backache and are not the cause of them. Expertise in pain relief during labour greatly supports a woman’s desire to experience a normal delivery.
What is linea nigra. Why do we get it during pregnancy?
Linea nigra is a Latin phrase which means ‘black line’. It refers to the dark line in the centre of the belly running from the pubic bones below to the navel above and sometimes even beyond. This is most commonly seen during pregnancy. This line is always there even before pregnancy though it may not be noticeable because of its light colour. At that stage it is referred to as Linea alba or the ‘white line’. The dark colour during pregnancy is caused by the hormone melanin, produced by the placenta. Similar darker pigmentation can also be seen around the nipple, the butterfly pattern on face – the ‘mask of pregnancy’ and on several other areas of the body like the armpits. Many women get alarmed when the Linea nigra appears around 6th month of pregnancy but there is no need for concern. This is a natural and normal phenomenon and has absolutely no bad effects on the pregnancy itself. It’s simply part of the changes that happen during pregnancy. Most certainly it will lighten after delivery or latest after breast feeding is over. The only impact of this change is cosmetic in nature. Women who are embarrassed by it can simply cover up with clothes or concealers. It is important to avoid exposure to the sun by wearing appropriate length of clothes. Other than that it doesn’t justify treatment of any kind. However, if this darkening of the Linea occurs in the absence of pregnancy it could signify a hormonal problem with the adrenal glands. Sometimes it may also be seen in women with Poly Cystic Ovarian Syndrome. So the appearance of Linea nigra without pregnancy justifies investigation and treatment. Other than that, when occurring in pregnancy, it can simply be ignored and considered as a temporary ‘prize’ of pregnancy which has no bad internal effects on the pregnancy or baby.
What is mask of pregnancy?
About 50-70% of women experience darkening of the skin of the face during pregnancy, during oral contraceptive intake or while on hormone replacement therapy in menopause due to the increased hormones, Estrogen and Progesterone . This occurs in a particular pattern, in the shape of a butterfly with darkening of the cheeks, nose, upper lip and forehead; or else it may occur as blotchy, darkened patches distributed over the face. This is known as the ‘mask of pregnancy’ or melasma or chloasma. This represents an increase in melanin which is the pigment which gives skin its colour. Its main purpose is protection of the skin from the harmful effects of sunlight. In most women this discolouration is a temporary phenomenon which will most likely disappear after pregnancy, or soon after breast feeding is over. One way to prevent this mask of pregnancy from becoming semi-permanent is to take care during pregnancy by protecting the skin from exposure to sun. Even a 5 minute sun exposure is enough to cause changes in the skin. This means that during pregnancy even if you go out to put washed clothesout to dry, you should be having your sunscreen on. You need sunscreen even at home since windows do not filter out the harmful rays of the sun. Generally speaking, a SPF (Sun Protection Factor) of 15 will protect you for 150 minutes. Therefore you need to renew your sunscreen application every 2- 4 hours depending upon the protection factor of your lotion. SPF of more than 50 has not found to be more effective. Most sunscreens protect against UVB (Ultraviolet rays B) which are responsible for skin cancer and sunburn. Choose a lotion which provides protection against both, UVB and UVA since the latter too can cause skin cancer. Your dermatologist can help with several medicated options too. In the meanwhile, in addition to sunscreen/sunblock lotions use sunglasses to protect your eyes and an umbrella every time you go out in the sun. Check your vitamin D levels in the blood because you are limiting sunlight exposure and vitamin D is prepared in the skin from sunlight. If deficient, add vitamin D to your diet but be safe from cosmetic and otherwise harmful effects of sun.