Every year in the United States, more than 4 million babies are born, with an estimated 30 percent of newborns arriving via cesarean section. That means, 1.2 million C-sections are performed annually.
It’s a trend that has increased by more than 50 percent since the 1950s and many believe it will go even higher in the future.
“Most women who have had a C-section tend to have a second or third,” said Dr. Manny Alvarez, senior managing editor for FoxNewsHealth.com and chairman obstetrics and gynecology at Hackensack University Medical Center in New Jersey.
So why so many?
Alvarez said the reasons are multifactorial and include:
-- Mothers becoming pregnant later in life;
-- More reproductive technology including IVF;
-- Large-sized babies due to the diabetic epidemic.
As with any surgery, these rising numbers and repeat C-sections mean there is always a possibility of complications. One potential complication includes abnormal placentation, or placenta accreta.
Abnormal placentation, which happens in about 1 in 2,500 pregnancies, occurs when the placenta implants itself very deeply in the uterine wall or in some cases near a previous C-section scar and the cervix.
“Placentation is something that occurs naturally and where the placenta lands and how it behaves is a process that cannot be controlled,” Alvarez said. “Diagnosing is the key, as is picking the right doctor and hospital.”
Dr. Abdulla Al-Khan, section chief of the division of Maternal Fetal Medicine & Surgery in the Department of Obstetrics, Gynecology & Women's Health at Hackensack University Medical Center in New Jersey, has created a new program, which is unique in the country, designed especially for mothers with abnormal placentation in hopes of saving lives.
The Center for Abnormal Placentation at Hackensack has a team of vascular surgeons, neonatologists, urologists and anesthologists who are ready to deal with a mother who may have a potential bleeding problem, which is the primary concern for the mother, due to the placenta being too deeply implanted in the uterine wall. What this means, is that the placenta may not spontaneously detach from the uterus.
“As a result, many women with abnormal placentas will need to be delivered much earlier than the due date,” Al-Khan said.
The average patient with placenta previa or placenta acreta tends to deliver between 34 and 35 weeks.
“The rationale behind this delivery is that you do not want the women to go into labor and increase the chances of them bleeding,” Al-Khan said.
Doctors used to say ‘once a C-section, always a C-section,’ as the scar from the previous surgery could tear during labor, but the debate has changed dramatically in the past year.
The American College of Obstetricians and Gynecologists have been forceful in recommending that obstetricians have an in-depth conversation with their patients about trying a vaginal birth after a c-section.
Al-Khan said he agrees with this theory if the conditions are adequate.
“I think you have to be cautious – you have to look at the size of the baby and the woman’s history – but if she is the right candidate, she should be encouraged to deliver vaginally,” Al-Khan said.