Dr. Banka Soujanya Discusses Conceiving Late and Its Relation to C-Sections (Part-6)
Dr. Banka Soujanya is a Consultant Obstetrician and Gynecologist. She completed her MBBS in 2012 from Government Siddhartha Medical College, Vijayawada, Andhra Pradesh, India. Later, she completed her post-graduation in DGO (Diploma in Gynecology and Obstetrics) in 2019 at Prathima Institute of Medical Sciences, Karimnagar, Telangana, India. She holds a Fellowship in Minimal Access Surgery (FMAS) and a Diploma in Minimal Access Surgery (DMAS). She also has a Diploma in ART (Germany, online).
She has a total of 9 years of experience. She is currently working at Reach Hospitals, Bachupally, and Dr. Vivaswan's Indira Clinic, Pragathinagar, Hyderabad, Telangana, India.
Dr. Banka Soujanya specifically deals with obstetrics and high-risk pregnancies, gynecological issues, laparoscopic surgeries, infertility issues, adolescent and menopausal issues, contraceptive advice, family planning, cervical cancer screening, and vaccination.
In this interview with MedBound Times, Dr. Banka Soujanya discusses does conceiving late leads to a C-section, conditions where planned or emergency C-sections are done, and strategies to save both mother and baby.
Vaishnavi Malvankar: We often hear that women are conceiving later in life due to societal pressures to prioritize their careers. However, is it necessary to have a C-section if one conceives later? I've heard people say that even if we maintain a healthy lifestyle, exercise regularly, and have no pre-existing health conditions, a C-section is unavoidable for those who conceive later. What are your thoughts on this?
Dr. Banka Soujanya: No, not at all. If the woman is 35 or 38 years old and physically fit with no complications such as diabetes or hypertension, we proceed normally. If the baby is in a good position and all antenatal checkups have had no issues, both mother and baby are fit to proceed to a delivery date. Then we will wait even for the delivery date, even on the expected delivery date. We allow her to go spontaneously set into labor, if it doesn't happen, we will induce labor using medicines.
According to the induction process, we assess the progress of both the baby and the mother's condition are? Accordingly, we might take a decision based on the observations, but it's not strictly for Cesarean section after 35 years. If you have conceived through IVF or IUI, it doesn't mean she will require a cesarean section. Decisions are based on the 9th-month assessment, which may include ultrasound, physical examinations, pelvic examinations, or checks for any complications during pregnancy. Based on observations, we make the decision. It's a myth among people that conceiving after 35 or 38 years automatically leads to a c-section, which is not true.
Vaishnavi Malvankar: What are the situations that necessitate planned C-sections, and what conditions might lead to emergency C-sections during labor?
Dr. Banka Soujanya: In a planned C-section, there are several typical indications. First, if I had to categorize planned C-sections for first-time pregnant women or women pregnant for the second time, certain factors play a role. Suppose a woman is planning delivery for the first time, and her placenta is low-lying, such as Placenta previa, where there is no passage for the baby to exit. In this case, elective Cesarean section is a clear and necessary choice. This is a scenario of Placenta previa.
The second scenario arises when the baby is in a breech-like position. It means that when the head is down, we expect a normal delivery in the first pregnancy itself. However, if the baby's head is up and the legs are down, then it is a clear indication of a Cesarean section. If a baby is lying in a horizontal position, a C-section may be necessary. Additionally, some women may experience infections, such as HPV or a high viral load of HIV. In these cases, there is a risk of transmitting the virus to the baby, which can also make a C-section necessary. Furthermore, if there are cervical infections or polyps blocking the passage, a C-section would be required.
Overall, we have about seven to eight absolute indications for a Caesarean section. However, it is essential to prepare them from the first month of pregnancy.
The first point to emphasize is that every woman preparing for delivery should not limit her mindset to just the idea of a normal delivery. It is important to be open to the possibility of an emergency C-section. This is significant because women who have specific expectations about their delivery may be more vulnerable to postpartum depression or postpartum psychosis when faced with unexpected outcomes. The primary goal should always be to have a healthy baby, rather than focusing solely on the type of delivery.
When it comes to emergency C-sections, explaining the situation to the patient and their family can be quite challenging for doctors. We may wait all day for normal delivery, and if labor does not progress and we need to decide on an emergency C-section at night, communicating that decision can be stressful. If the baby is in fetal distress and the heart rate is declining, this creates further anxiety for the family. We must address questions like whether this is the right time for a C-section or if we should wait and monitor the situation. Convincing the family, explaining the rationale behind our decision, and addressing the potential complications associated with the procedure are all part of the challenges we face during emergency C-sections.
Vaishnavi Malvankar: What are the main strategies you use to save both the baby and the mother?
Dr. Banka Soujanya: We have specific protocols in place for all gynecologists and obstetricians within our hospital. When a patient is being induced for a normal delivery, we ensure that the anesthetic team and the pediatrician are informed, promoting a multidisciplinary approach. It is crucial to have the entire team accessible at all times.
The primary risk I anticipate during the procedure is bleeding, so it is important to have blood products readily available, along with medications to control any bleeding that may occur. Tissue handling must be gentle and careful to avoid complications in the future and to prevent adhesions that could damage organs.
Decision-making by the gynecologist or obstetrician should remain calm and composed. If the gynecologist is stressed or raises her voice, it can create discomfort for the patient in the operating room. In the present situation, the baby may not be delivered normally, which could decrease the chances of a normal delivery and result in a C-section.
As we prepare for the procedure, I am getting ready in the operating room and ensuring the team is prepared as well. The patient should be ready to accept the situation. We strive to communicate with her, keep her informed, and reassure her that the baby is doing well. Providing her with comfort and confidence is vital, and we remind her that the team is right beside her and that the necessary blood products and medications are on hand.
There are intrauterine devices, such as Bakri balloons, that can help prevent postpartum hemorrhage, and these should be available in the operating room. We must be prepared to address any complications that arise during the procedure and take the necessary steps to prevent bleeding, ensuring the safety of both mother and baby. Our ultimate goal is for both of them to leave the hospital happily and with smiles.
Stay tuned for Part 7, which will cover the criteria for performing a C-section during active labor. We will also discuss the likelihood of a normal delivery if the first delivery was a C-section and whether there is a chance for a normal delivery if the baby's head is not positioned downward.
