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Lori is scheduled for her third C-section this week and emailed with this question: "I've been having contractions for several nights and I'm worried I'll dilate too fast for the doctor to do my C-section in time. How do I know when to call the doctor?" Lori's questions open up quite a few areas for discussion. We'll talk a lot about C-sections in future blogs but this week we'll discuss contractions, scheduled C-sections and phone calls.
Question 1: You're scheduled for a C-section and start contracting. What should you do? Obstetricians (midwives and family practice doctors don't do C-sections) usually schedule repeat C-sections for week 38 or 39 when Baby's lungs are fully developed but it's not so close to the due date that labor's likely to start. Like Lori, lots of women have contraction-flurries during the final weeks of pregnancy. Its the uterus' way of working out—getting ready for the big day. These contractions align baby's head in the birth canal; soften, thin and properly position the cervix (opening to the uterus) before dilation. Most of the time, these contractions aren't painful—just annoying. Apparently, Lori's uterus didn't get the memo that practice was cancelled on account of C-section. If the contractions don't hurt, are infrequent and go away after a spell, she should call her doctor during the daytime hours and let him/her know about them. He might have her come into the office or hospital for an ever-popular vaginal exam to check dilation. If she's dilating, these contractions are doing their job and she might get her C-section sooner than originally planned. If she isn't, she'll probably be encouraged to rest, drink more water (diluting the contraction-causing hormones running around her bloodstream) and keep the doctor informed if they start up again.
What if they don't go away or they hurt? Call the doctor. Yep, even in the middle of the night. She may get the answering service and there's a good chance her doctor won't be on-call. No problem. There's always, ALWAYS, a doctor available for phone consultations. The answering service will have the doctor-du-jour call back. Lori will describe her contractions and any pertinent health info and together, they'll make a plan. If Lori's in labor and needs a C-section immediately—the L&D unit can do one at the drop of a hat. We do C-sections all the time. We can whip together a surgical team and deliver a baby speedy-quick.
Question 2: Why is Lori having so many C-sections? Lori didn't say why she had her previous C-sections but nowadays, once a C-section, always a C-section. OK, that's not actually true but the trend is that lots of doctors and hospitals don't do Vaginal Birth After Cesarean (VBAC) anymore because there are some rare but scary risks associated with them.
Women need scheduled C-sections for lots of reasons. Maybe Lori's teeny-tiny and her husband's a giant. That makes for a difficult fit for a vaginal delivery. Maybe she had an active herpes outbreak at the time of delivery. Herpes causes central nervous system and organ damage in babies. C-sections keep babies away from the lesions, minimizing risk of mom transmitting the virus. Maybe Lori is HIV positive. C-sections minimize exposure to the baby. Maybe Lori's placenta grew over the cervix. Delivering a baby through the placenta could cause both mother and baby to bleed to death. Not good. Maybe Lori has a breech baby or twins. Maybe she just wants a C-section. That happens sometimes too. Having had one with a previous delivery is just one of a million reasons why women schedule C-sections.
Question 3: Who do you call when you don't know what's going on? Your mom, midwife, doctor or the L&D unit are all good choices. We get weird symptoms late in pregnancy. It's the freakiest process your body's ever been through and all kinds of crazy stuff happens. You contract like crazy when you're up and walking but they settle down when you rest. You've got a brownish-red discharge. You've got a backache and haven't slept for nights. You're a cranky crybaby. What's going on? Is it labor or not? Hard to know. When you're emotional and annoyed, call your mom (or sister, doula, friend who's had a baby) for advice and sympathy.
Call your doctor with medical concerns. Use some common sense. 3AM is no time to call wondering if you can eat sushi. If you're worried you're in labor though, don't worry about waking the doctor up— you're not bothering her. She's on-call. Most doctors take turns with their partners. If it's her night on-call, she's expecting the phone to ring. Doctors knew about the lousy hours when they took this job. Or call the L&D unit and talk to a nurse. She might tell you to come to the hospital for evaluation. We hesitate to give too much advice over the phone because we can't make a good assessment without seeing you. We understand though that sometimes, a little phone reassurance is all you really need.
Side note: If at all possible, make the call yourself. Don't have your husband call. He'll just have to translate the doctor's questions to you and then your answers back. It wastes time and a lot of information gets lost in translation. We can tell a lot about how you're feeling by the way you talk. So, who you gonna call? Ghostbusters. Aw, c'mon, you knew that was coming.
Got a question for Jeanne? E-mail it to firstname.lastname@example.org and it may be answered in a future blog post.
This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.