"pushing" and ppcm/heart issues

[momofthree]

Dear Dr. Fett (and again, any other informed ladies),

Why C-sections on babies who are post-ppcm babies? Is pushing hard on the heart? I had natural labor and delivery with my ppcm baby. Boy did I work on that one. The first one I had was with an epidural and I did push but I did not feel anything obviously. Anyway, I just wondered. Strangely it has been on my mind lately. (I have three but the middle is adopted...must include him). What do you think? My tailbone actually "popped" out of place and caused unbelievable pain following delivery for a long time. Regardless, I guess my question is why a C-section and would it make a difference? Thanks. Alison

[tabs]

Alison, I think each doctor has their own ideas on the best way to deliver post PPCM babies. Research is definately needed in this area. My doctors actually preferred a vag delivery with early epidural.

Here is my understanding of the issues:
C-section pros - controlled setting, no pushing
cons - fluid shifts post delivery, blood loss, complications from major surgery

vag delivery pros - natural for the body, slow, no real fluid volume shifts
cons - pushing can be a strain on the heart, pain changes body responses (ie heart rate, BP), if something goes wrong an emergency C-section is needed.

Many of the cons for vag delivery can be mitigated by an early epidural, but some hospitals still give huge amounts of fluids with the epidural.

Twilah

[JAMESFETT]

I would work closely with the obstetrician on this. It is a matter of timing. If heart function is perfectly normal there is not much reason to not "let nature take its course." A normal labor and delivery should be no problem in that situation. If heart function is borderline or appearing to deteriorate there is an advantage to wait no longer if the baby is considered mature and ready for birth, so the Cesarean will help to avoid any extra stress of prolonging the pregnancy and going through labor. The main risk of Cesarean to the mother and unborn is the anesthesia, but in good hands that should not be a problem. Importantly, mother and child are first concern and the cardiologist, obstetrician, and perinatologist (or pediatrician) should all be involved in the decisions and process.

James