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C-SECTION after C-SECTION

C-section means that a baby is born by a surgeon cutting open the uterus and removing the baby through the abdomen. A report in today's New England Journal of Medicine shows that women who have already given birth to a baby by a C-section, are three times more likely to rupture their uteri when they try to deliver the next baby through the vagina. It is uncommon for a woman to rupture her uterus, but it can kill the mother.

Since I have been in practice for more than 40 years, I can give you perspective on this that few news media can. Obstetricians have always known that the safest way to deliver a baby is by C-section. On the first delivery, the baby's head is used as battering ram to open the cervix, so the baby can pass. Brain hemorrhage at delivery can occur. Female obstetricians are 12 times more likely than average to have a C section birth. The female obstetricians are willing to undergo inconvenience of surgery to protect their babies.

In the late 1970s and early 1980s, patient rights groups and feminists attacked doctors for doing too many C sections. They were so loud and so vicious, that many doctors became afraid to perform C sections and the rate of C sections went down, and the rate of difficult deliveries and brain damage went up.

Now, researchers at the University of Washington show in today New England Journal of Medicine that women who attempt vaginal deliveries after having had one C-section are 3 times more likely to rupture their uteri. The scar from the previous surgery is much weaker than an intact uterus.

What does that mean for you if you are a woman who is planning future pregnancies? Plan to have a regular vaginal delivery. However, if the baby's head is too big to pass through your pelvis, the labor takes too many hours, or there is sign of damage or distress to the baby, get a C section immediately. It is the safest way to deliver the baby. Sometimes, the feminist movement knows more about politics than about medicine.

NEJM Feb 4, 2001

May 12th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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