Baby’s first breaths and what you didn’t know about her first cries

Dear Dr. Mo: I’ve read your post on C-section and I wanted to know more about what you’ve said were risks for ‘increased respiratory problems of the newborn’ with C-section delivery. Also, why do babies always cry when they’re born?

Oxygen isn't just explosive - it burns

Oxygen isn’t just explosive – it burns

Dear reader: Your questions about newborn’s breathing at the instant of birth and crying are important and could prompt a very technical answer, which I will try to avoid here.

Let’s just imagine a baby floating in water for 9 months – this is the baby’s natural environment in the womb. The baby doesn’t breathe the way she will breathe after birth and so the water fills up her lungs. The natural act of birth is so important because the birth canal through which the baby is traveling pushes on the baby and squeezes out that fluid (almost all of it) from the lungs and compresses the lungs so much that at the instant both of baby’s shoulders are delivered, the lungs automatically and involuntarily inflate taking that first and only passive breath the baby will ever take. Every following breath, for the rest of her life will be active breathing effort.

So you see, if this natural pathway of delivery is circumvented via C-section, the baby’s lungs don’t have the assistance to expel the fluid out and the newborn may have some problems with breathing in the first few hours – this manifests itself as a very rapid breathing called tachipnea and it’s in most cases transient. Sometimes though, more serious breathing problems can occur and if this rapid breathing does not go away within 4 hours, we always have to rule out sepsis as the most dangerous complication.

Now about that crying, there’s a myth here to debunk: Continue reading

Cesarean versus vaginal delivery – which to go for and why?

Dear Dr. Mo: I’m due soon and I’ve been considering to ask for a cesarean birth – what would you medically recommend a woman should go for, normal or cesarean?

No matter how you deliver, this is your future

No matter how you deliver, this is your future

Dear reader: What you are considering is what we term a Cesarean delivery (C-section) on maternal request, in which case you would undergo a planned C-section delivery before the natural onset of labor, without you or your baby really medically needing it and in such scenarios, I tend to advise against it.

But here’s the thing:

The reality is that there’s no good evidence to facilitate a textbook counselling in this case and most of the available data comparing the two delivery routes (planned C-section versus planned vaginal delivery or what you refer to as ‘normal’) is weak and ought to be interpreted cautiously.

Things to consider:

When you desire a cesarean delivery, your doctor should consider your specific (risk) factors, such as age, body mass index (i.e. if you’ve gained a lot of pregnancy weight, any surgery is more risky), accuracy of estimated gestational age (i.e. C-section on maternal request should not be performed before a gestational age of 39 weeks which is full term), reproductive plans for the future, personal values, and cultural context. I know that sometimes, some past experiences (e.g, violence, trauma, or poor obstetric outcomes) and anxiety about the whole birth process may be what’s prompting such requests and if any of these are what concerns you, bring it up with your doctor.

If your main worry is pain during delivery, then prenatal childbirth education, emotional support in labor (i.e. your partner or someone else close to you could attend), and anesthesia for childbirth (epidural) should be offered and could eliminate this issue entirely. Continue reading

How to recover from a Caesarean (C) section?

Dear Dr. Mo: How to recover from a Cesarean section?

Dear reader: It is important to know that, after any surgery, the recovery is done in stages, it is gradual and it takes some time and effort but in the end, all was worth it.

After an intensive care unit (ICU) in which you are taken immediately after surgery to wear off the anesthetic and to wake up (length of time spent there varies, depending on the type of anesthesia, its intended duration and complexity of your surgery) while being closely monitored for vital signs and for uterus firmness and possible bleeding from the uterus (it should contract down – this could be painful), you are moved to your room – usually after a couple of hours. In it you spend the rest of the hospital recovery and there you usually have your first contact with the baby.


Recovery may be painful but it will happen

The best word of advice I can give to anyone recovering from a Caesarian section (C section) is to begin to move as soon as possible. This movement you can start while still in ICU with breathing – as simple as it may sound, it is not – taking deep breaths could be difficult and this little exercise should be undertaken as early on as possible and as frequently as possible.

Once in your room, you may still be hooked up to some equipment like the I.V. drip, blood pressure monitor, you may still have your catheter inserted although it is removed early in the recovery process.
Your intestines need to start working again and until that happens, the I.V. line will likely remain. You will know when they re-start – you will hear and feel the sounds of deep rumble and should start passing gas (this may cause some pain as the gas build up stretches the intestines). All this is good development and albeit somewhat painful, it is an important event and most of us are relieved when it occurs.
Avoid cold, hot and carbonated drinks as they could worsen the gas issue. Continue reading