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Mostly Third of Childbirths are Cesareans

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The cesarean birth — delivery via uterine incision — was once reserved for cases in which the life of the baby or mother was in danger. But now it is a routine practice. It is in fact the most common operation in the United States; performed in 31 percent of births, up from a mere 4.5 percent in 1965.

With that surge has come an explosion in medical bills and an increase in complications. Now, the use of cesareans is being reconsidered. It is a major reason childbirth often is held up in healthcare reform debates as an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results, and may actually be doing more harm than good.

Childbirth is the number one cause of hospital admissions, and is a huge part of the nation’s $2.4-trillion annual healthcare expenditure. Spending on the average uncomplicated cesarean runs from $4,500 to $13,000, much more than a comparable vaginal birth. And the cesarean rate in the U.S. is higher than in most other developed nations despite a standing government goal of reducing such deliveries.

The cesarean also exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans have been shown to increase premature births and the need for intensive care for newborns. Even without such complications, cesareans result in longer hospital stays.

Sources: Los Angeles Times May 17, 2009

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Birthing Chair to Give Relief to Mothers

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The problem of excruciating delivery pain experienced by women during childbirth seems to have found an answer in birthing chairs, now  popular in the west.

A private hospital in Kolkata is all set to introduce birthing chairs for would-be-mothers to reduce the painful process to some extent.

CLICK & SEE THE PICTURES

“Birthing chair helps women deliver much easily in shorter time. We will soon have one such chair in our hospital to begin with,” said Kamal K. Dutta, diplomate of American Board of Obstetrics and Gynaecology and chairman and managing director of Ruby General Hospital.

In India delivery takes place in lying posture. But he said, “During earlier days, around 100 years back, people used to give birth in sitting postures. They used to sit and push and the gravity helped the baby come out. Let us help the mother to deliver.”

Describing the utility of the chair, being introduced for the first time in eastern India, he said it is more comfortable and hoped women here would slowly start accepting this new technique.

“At first we will import one chair from the US. And display it in the maternity unit and show it to the pregnant women and make them aware of its utility,” Dutta, a non-resident Indian, said.

Each chair costs around $20,000.

“In the first stage the mother is lying on the bed, then she has the urge to push the baby out and the whole process becomes convenient in sitting posture. It is difficult to do this while lying on the bed,” he said.

Dutta laid stress on increasing the number of normal delivery in India compared to caesarean.

“We are keen to increase the number of normal deliveries in India. Normal deliveries are safer and reduce the chances of infection and bleeding after delivery,” he said.

In the US, 70% of deliveries are done on the birthing chair.

To increase awareness among people, Dutta is planning to start pre-natal classes to educate pregnant women. “We will show them the video of normal and caesarean delivery, the birthing chair and let them decide which one they want to opt for.”

In his bid to popularise normal delivery, he said, “We will guarantee that there will be no pain. We will use epidural anaesthesia to continuously decrease the labour pain.”

Epidural anaesthesia is a local anaesthesia to reduce to pain.

Dutta, who left India in 1976 for the US, practises at New Jersey and is a Fellow of American College of Obstetrics and Gynaecology, says he wants to break the ‘myth of pregnancy’.

“Here people are scared of the pain, that’s why they opt for caesarean delivery. Let’s see whether we can break the myth,” he said.

Leelavathi Hospital in Mumbai already has a birthing chair.

Noted gynaecologist S Dawn expressed happiness at the birthing chair becoming available in eastern India, but said the cost could be prohibitive.

“This is a good drive that someone is bringing the chair into this region. It will give some comfort to the patients. But one should have proper infrastructure and this is an expensive way,” said Dawn, also secretary general of Narchi, an NGO of doctors.

Sources: The Times Of India

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Ailmemts & Remedies

Cervical Incompetence

Definition:
In medicine, cervical incompetence is a condition in which a pregnant woman‘s cervix begins to dilate (widen) and efface (thin) before her pregnancy has reached term. Cervical incompetence is a cause of miscarriage and preterm birth in the second and third trimesters.

In a woman with cervical incompetence, dilation and effacement of the cervix occur without pain or uterine contractions. Instead of happening in response to uterine contractions, as in normal pregnancy, these events occur because of weakness of the cervix, which opens under the growing pressure of the uterus as pregnancy progresses. If the changes are not halted, rupture of the membranes and birth of a premature baby can result.

CLICK &  SEE THE PICTURES

Sometimes premature effacement (shortening of the vaginal portion of the cervix and thinning of the walls) and dilation of the cervix is not caused by labor, but rather by structural weakness in the cervix itself. This is called cervical incompetence.

The weakness can result from a number of conditions, most due to prior injury to the cervix or resulting from an inherited physical condition of the cervix.

Description of Cervical Incompetence:
When the cervix is damaged, it cannot hold the weight of the pregnancy. The cervix dilates without contractions or pain, sometimes opening completely. The dilation results in the amniotic membranes bulging through the opening and eventually rupturing, often before the baby can survive outside of the uterus. This irritates the uterus and brings on pre-term labor. In many cases, labor is detected when it is too far advanced to stop the process.

Click for Pictures of ultrasonographic findings: at 19th week of pregnancy

The cervix normally stays closed until labor begins. however, if the cervix has been weakened, a condition known as cervical incompetence, the weight of the growing fetus and its surrounding amniotic fluid may cause the cervix to open early, resulting in a miscarriage. cervical incompetence is the cause of about 1 in 4 miscarriages after the 14th week of pregnancy.

Causes:

The cervix may be weakened by previous surgery, such as a cone biopsy, or by any procedure that involves artificial opening of the cervix. for example, a woman who ahs had more than three terminations of pregnancy at an early stage is more likely to develop cervical incompetence.

Symptoms :

Often there are no symptoms of cervical incompetence before miscarriage occurs. at this stage, the mother may feel pressure in the lower abdomen or a “lump” in the vagina.

Women with incompetent cervix typically present with “silent” cervical dilation (i.e., with minimal uterine contractions) between 16 and 28 weeks of gestation. They present with significant cervical dilation (2 cm or more) and minimal symptoms. When the cervix reaches 4 cm or more, active uterine contractions or rupture of membranes may occur.

Diagnosis:
Diagnosis is made by medical history, physical exam, and ultrasound study. A pregnancy test will also be performed.

What might be done?
If you have had a previous miscarriage after the 14th week of pregnancy, your doctor will probably suggest that you have ultrasound scanning to look for evidence of cervical incompetence. The scan is performed through the vagina to measure the thickness of the cervix and may be carried out at an early stage in your next pregnancy or, if possible, when you are planning a pregnancy. If you are at high risk of cervical incompetence, possibly because of previous surgery on the cervix, you may also be investigated for cervical incompetence before or early in pregnancy.

Treatment :

Once the problem of incompetence is diagnosed, the condition may be treatable through a surgical procedure called cerclage (stitching the cervix closed). One or more stitches are placed around or through the cervix to keep it tightly closed.

This is usually performed after the twelfth week of pregnancy, the time after which a woman is least likely to miscarry for other reasons – but it is not done if there is rupture of the membranes or infection.

After surgery, the mother is carefully monitored to check for infection and contractions, which are sometimes brought on by the procedure. After hospital discharge, the patient may remain on bedrest in order to remove any pressure on the cervix and increase the chance of retaining the pregnancy until the baby is viable. The cerclage is usually removed just before childbirth so that the patient can give birth vaginally. In some cases, the cerclage may be left in place, and the baby is then delivered by cesarean section.

Risk Factors:

Risk factors for an incompetent cervix are: a history of incompetent cervix with a previous pregnancy, surgery, cervical injury, DES (diethylstilbestrol) exposure, and anatomic abnormalities of the cervix. A prior D&C can, for example, damage the cervix.

Other causes of cervical weakness include cervical cautery (to remove growths or stop bleeding) and cone biopsy (removal of a cone-shaped section of tissue for study to detect possible precancerous growth). Prior to pregnancy or during the first trimester, there is usually no method to determine whether the cervix will eventually be incompetent.

If the cervix is weak, a stitch can be inserted in it to hold it closed. the procedure is usually done under general or epidural anesthesia between week 12 and week 16 of pregnancy. the stitch will be removed at 37 weeks, before the beginning of the labor. If labor starts while the stitch is still in place, it will be removed immediately to prevent the cervix from
becoming torn. If the stitch fails to prevent a miscarriage, another pregnancy may be successful if a stitch is inserted higher in the cervix.

Cervical incompetence is likely to be a problem in subsequent pregnancies. The cervix may need to be stitches each time to prevent miscarriage.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.healthscout.com/ency/68/361/main.html
http://www.charak.com/DiseasePage.asp?thx=1&id=285
http://en.wikipedia.org/wiki/Cervical_incompetence
http://pennhealth.com/health_info/pregnancy/000194.htm