COMPLICATIONS

My first child was delivered by Caesarean section. Do I have to have a Caesarean section with my next pregnancy?

It depends why you had the Caesarean section. If it was performed for an obstetric reason that is likely to be present in the next pregnancy, the answer is yes. If it was performed because the first baby was large or just because you have diabetes, the answer could be no.

Some doctors do consider it safer to deliver a woman by Caesarean section if she has had a Caesarean section before. Others would allow you a ‘trial of labour’. In other words, you would start labour and, if everything was satisfactory, you would be able to deliver your baby in the normal way.

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My doctor tells me that I will have to have a Caesarean section because my baby is in a bad position and a little large. What sort of anaesthetic is best?

Nowadays approximately 50% of women who need a Caesarean section have an epidural rather than a general anaesthetic. If you have an epidural your legs and abdomen are made completely numb by injecting local anaesthetic solution through a needle into your lower back. You remain awake for the birth of your baby and therefore remember this major life event. In most cases an epidural is preferred because your baby receives none of the anaesthetic and therefore is not sleepy.

If you are interested in having your baby this way, you should discuss it with your obstetrician.

My baby had difficulty with breathing in his first few days in the Special Care Baby Unit. They said this was because my control of my diabetes was poor -why was this?

It sounds as if your baby had what is called respiratory distress syndrome (RDS) which occurs most commonly in premature babies and was discussed in an earlier question. It occurs in babies of mothers with diabetes where the baby has grown too quickly because of the mother’s poor blood glucose control, and requires a premature delivery. It used to be a serious threat to the babies of mothers with diabetes but now it is much less common. This is because of advances in neonatal care and better control of diabetes in pregnancy resulting in fewer premature deliveries.

If there is a possibility that your baby may be born prematurely, treatment with a steroid injection can help your baby’s lungs to mature. Unfortunately the steroids can upset diabetes control for about 48 hours and you will need to be in hospital for close supervision at this time.