The early weeks of pregnancy are fragile—and confusing. Here, the answers to your questions.
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Having an episiotomy
An episiotomy is an incision that widens the vaginal opening so the baby’s head can pass through more easily. For decades, obstetricians routinely performed episiotomies, believing an incision would prevent serious tears and pelvic-floor muscle damage, which can contribute to incontinence. But new research has found that nearly 8 percent of women who have episiotomies develop serious tears, compared with 3.6 percent of women who don’t have them, and that the procedure may increase, not reduce, damage to pelvic-floor muscles. ACOG denounced routine episiotomies in 2000, but some doctors continue to perform them needlessly. An episiotomy is warranted when a forceps or vacuum-suction delivery is needed, when a baby is very large or needs to be delivered quickly. Ask your doctor what her episiotomy rate is and what factors prompt her to perform them. — laurie tarkan
Trying for a VBAC
In the early ’90s, when many women learned they could safely deliver vaginally after a prior C-section, the rate of VBACs (vaginal birth after C-section) rose steadily—by 50 percent—until 1997. Then came reports that VBAC increased the risk of uterine rupture, an emergency situation that’s potentially deadly for both mother and baby. The VBAC rate plummeted from 28.3 percent in 1996 to just 12.7 percent in 2002. Research later reported in The New England Journal of Medicine found that the risk for uterine rupture was largely linked to certain induction drugs. Today, many doctors say VBAC is safe, as long as labor is not induced. But the most important precaution is choosing a hospital that is prepared to handle VBAC emergencies. Before attempting a VBAC, consult with your doctor; she’ll take into consideration why you had the prior C-section, the type of incision you had, whether you had a fever afterward and other factors. — L.R.S.
Dealing with labor anxiety While just about every pregnant woman feels some anxiety about labor and delivery, 6 percent to 10 percent suffer intense fear that manifests itself as nightmares, physical complaints, difficulty concentrating or other symptoms. If left unchecked, fear and its associated stress can contribute to both early and late deliveries, smaller babies and a higher risk for emergency C-section. What’s more, frightened women may actually experience more discomfort during childbirth, says Alice D. Domar, Ph.D., a Harvard Medical School expert on stress. Prenatal distress also is associated with postpartum depression and difficulty bonding with the baby. The good news is that there are ways to reduce your fear of childbirth. Here are six of them:
1) Track the source Certain experiences can trigger an intense fear of labor; these include past abuse or rape, miscarriage or stillbirth; guilt over an abortion; a previous difficult delivery; and exposure to traumatic labor stories. 2) Don’t wait Deal with your fears at the beginning, not the end, of your pregnancy, recommends Heather Kleber, a certified childbirth educator and doula in San Antonio.
3) Consider therapy In one study, women with an intense fear of labor who underwent cognitive (talk) therapy had shorter labors and fewer unnecessary C-sections than those who didn’t.
4) Tell your doctor Just sharing your fears may help, and your physician may have ideas about how to reduce your anxiety. Also discuss your feelings about medication, laboring positions, episiotomy and similar issues during a prenatal visit
5) Shut out negative stories Don’t watch scary TV shows about childbirth, read horror stories or listen to friends recount the gory details of their labors.