ALBUQUERQUE, N.M. — Ellen Geske didn’t want her second daughter delivered by cesarean section, but a couple of issues in her pregnancy were making that a possibility.
Her baby was breech, meaning her head was up instead of down.
Also, she had an overabundance of amniotic fluid, she explains one afternoon at ABQ Health Partners Women’s Health on Montgomery.
Dr. Rita Leard, an obstetrician/gynecologist who heads the practice, says sometimes a c-section is necessary, but when conditions are safe for mother and baby it’s preferable for many reasons, including future pregnancies and quicker recovery from childbirth, to delivery the baby through the birth canal.
Geske, 31, and her husband, Caleb Robinson, had a toddler, Laina, at home: “I needed to be up and around as soon as I could.”
“It’s recovery from major surgery; you are in pain. It can be difficult to focus on a toddler. You can’t lift more than 10 pounds for six weeks,” explains Leard, adding a c-section also has the associated risks of a major surgery.
Now her daughter, Elise Robinson, is 18 months old, delivered through the birth canal.
Geske had come to the right place for a woman who wants to deliver her baby without surgery. ABQ Health Partners Women’s Health has one of the lowest c-section delivery rates in the country at 18.5 percent, a few percentage points lower than the state’s rate, Leard says. The practice delivers babies at Lovelace Women’s Hospital.
New Mexico’s 22.8 percent c-section delivery rate ranks the state as one of the best places in the country for a vaginal delivery, according to a table from the Centers for Disease Control and Prevention, National Vital Statistics. Alaska has a lower rate at 22.6 percent. The average nationwide is a little more than one in three births via surgical delivery.
A c-section also has future complications, according to a recent report from the American College of Obstetricians and Gynecologists: “The incidence of placental abnormalities, such as placenta previa (meaning the placenta is lower than the baby in the womb), in future pregnancies increases with each subsequent cesarean delivery. This combination of complications not only significantly increases maternal morbidity but also increases the risk of adverse neonatal outcomes such as neonatal intensive care unit admission and neonatal death.
“Although the initial cesarean delivery is associated with some increases in morbidity and mortality, the downstream effects are even greater because of the risks of repeat cesareans in future pregnancies.”
“The safety of the mom and of the baby are at the top of the list, of course, but we give them every chance for a vaginal delivery,” Leard says. They also help moms who have had a previous c-section deliver without a second surgery for the subsequent pregnancy, called a VBAC, if all other health factors are favorable, she adds.
Danielle Hoelter, Geske’s certified nurse midwife at ABQ Health Partners, recommended a procedure, called an external cephalic version, to turn the baby’s position for a head-first delivery and avoid a c-section. It’s done near time for delivery, in Geske’s case, at 37 weeks, when the baby would usually turn for birth.
Hoelter explains ultrasound tracks the position of the fetus, while it continues to be electronically monitored for vital signs. The mother receives medicine to relax her womb, so a physician, working from outside the abdomen, can gently move the fetus to a better spot for birth.
Although the first procedure succeeded, Geske required a second one before delivery because Elise had turned back again, Geske says.
“I did the exercises, but she turned again,” Geske says, explaining that she did a couple of exercises that lifted her pelvis higher than her chest, which are often recommended to encourage a fetus to turn head down into the birth canal.
Although her labor was lengthy, she had Hoelter for support and soon delivered Elise, who weighed 8½ pounds.
“It was great. There was no comparison between this birth and the last,” Geske explains, adding she had her first daughter through another local practice and where a physician delivered Laina. “I had to fight not to have a c-section.”
Geske’s first labor lasted longer, about 60 hours, but she ultimately delivered her baby without surgery.
“We make sure moms feel secure and safe,” Hoelter says. “We discuss all their options and make sure they are heard. We’ve delivered 69,000 babies here in the past 32 years.”
Long, unproductive labor is a medical reason for a c-section, Leard explains, but often what national clinical studies show is that normal, natural labor can last longer than previously thought: “We give labor a chance to happen.”
Leard explains that a c-section may become necessary for a breech birth because a baby’s head is the largest part of its body. If legs or hips move out first, it can wrench tiny shoulders or a head can get caught, she explains.
Leard says she attributes ABQ Health Partners’ low c-section rate to a collaborative practice between physicians and certified nurse midwives, which is less common across the country, she says. Also, an obstetrician and an anesthesiologist are on call 24 hours a day, seven days a week, in case they are needed, she says.
“This is the way obstetrics should be practiced. We have obstetricians and midwives working side-by-side,” Leard says. “It’s the best of both worlds.”