Interview with Dr. Jean-Giles Tchabo

In my last two posts (which you can read here and here), I talked about my experience approaching the delivery of my second child, after having an emergency c-section for my first. My OB/Gyn, Dr. Jean-Giles Tchabo was someone I found who encouraged vaginal deliveries after cesarean sections (VBACs) as an option for women in my situation, so I interviewed him for answers to common questions about VBACs.

In the first post we dispelled some of the myths of VBACs, and in the second we delved deeper into the topic with a series of reader questions around policies, and health issues. In this post, we turn our focus to issues and science involved in e
mergency c-sections.

What is the difference in terms of procedure and experience between an emergency c-section and a repeat c-section?

A crash c-section is not a good experience for anyone.  It can be traumatic for the mother and for the doctor they are heading into an unknown situation.  All that we know is that mother, baby or both are in distress, there is a trauma happening inside the mother, and we often don’t know what that trauma is until we begin the procedure.  For a doctor to call a crash c-section, it is an emergency.  The baby has to come out and come out fast.

For the mother in a crash c-section unfortunately her comfort comes second to saving the life of the mother and baby.  Additionally she is also likely not in a good state after having labored before the procedure.  She will be tired, hungry and dehydrated, which is all very taxing on the body.  It is not an easy procedure for the mother to endure.  At our hospital [Virginia Hospital Center] we try to have staff explain to her what is happening and try to calm her fears but depending on the seriousness of the situation there may not be time for that.  Baby has to come out and come out now.

For the doctor they don’t have time to plan.  They may not have the staff they would like to have on hand to support them during the procedure.  As I said before they are heading into an unknown situation. We can have indicators as to what is happening inside the mother, but we may not know why or the extent of the situation until the surgery begins and this is a situation that the doctor does not want to be in.

In a repeat c-section there is time for the doctor and team to plan and to make sure the mother is as comfortable as possible before the surgery begins.  The doctor will have all the information he needs about the mother with him.  There won’t be unknown complications making the procedure much more straight-forward and the doctor will have the team he needs on hand to help with the procedure.

For the mother they will be told not to eat after midnight the day of the procedure, and they will likely have bloodwork done to make sure there are no abnormalities and that if a blood transfusion is needed we have the right type on hand.  It is a completely different experience for the mother than a crash c-section.

I know this is a hard question to answer considering the variables that go into deciding whether a mother is a good candidate for a VBAC or not, but let’s say she’s a good candidate, what carries more risk to mother and child, a VBAC or a repeat c-section?

If the mother is a good candidate, a repeat c-section caries more risk than a VBAC.  Additionally the recovery from a vaginal birth is usually easier for the mother than recovery from a c-section.

A c-section is major surgery.  The doctor has to cut through several layers of skin, muscle and tissue to reach the baby.  It is not something to go into lightly.  There is risk of bleeding, risk from infection, risk that the mother may not heal correctly.  So long as the mother is a good candidate VBAC is always preferable to a repeat c-section.

What about the practice of delayed cord clamping during a c-section? 

This is not a new practice, this is something that we’ve been doing for sometime.  There is a benefit to the baby if we delay clamping and cutting the cord for 90 seconds to two minutes, this is something we do regularly.

But it is important to know that there are some circumstances where it cannot be done.  In the case of an emergency c-section the goal is to get the baby out and to safety as quick as possible, and leaving the baby attached at the cord interferes with that.  We also need to examine the mother to ensure that there is no infection or sources of bleeding, so we generally don’t do it during an emergency c-section.

We also can’t do it if the mother wants to bank the cord blood.  The idea is that the cord blood goes to the baby, so if the mother wants to bank the blood, there won’t be any left in the cord for her to bank.  We also cannot do it in cases of multiples.  Because there are two or three babies and we will have the uterus open for so long, it increases the risk of infection, bleeding and complications with the babies that have not yet been delivered.

We’ve also been asked about some pretty strange practices for c-sections and for vaginal births in general, but because we’ve been asked I feel I need to ask the question.  What are your thoughts on seeding and lotus births?

These are new practices and I don’t think very wise ones.  Yes, during a vaginal delivery the baby comes into contact with the vaginal flora of the mother and those good bacteria colonize in the baby’s GI system.  But to swab the mother’s vagina or anus after a c-section [as is the case in seeding] and then transfer the contents into the baby’s nose and mouth is not the same thing as what happens during a vaginal birth.  In terms of allowing the umbilical cord and placenta to fall off on their own [as is the case in a lotus birth] there is the increased risk of infection.  I have never performed any of these practices and don’t know of a doctor who has.

Now, there may be some midwives that do this, where there is a home birth and there is no one around to record what happens and they don’t have to explain it.  They may perform these procedures, but I don’t know of a doctor who has.

* And although we say it often, Julia and I need to say it again here: Never, ever, take medical advice from strangers on the internet, including from us!  Talk to your real-world physician before you make any medical decisions for yourself or your child.  SERIOUSLY!*

Disclosure: Dr. Tchabo delivered Leslie’s first baby and she used his practice for her second pregnancy although he did not deliver her second child.  She received no compensation or special consideration for this series.  This series ran several months after Leslie delivered her second child.

 

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Categories: Pregnancy, Birth + Family Planning, Science 101 + Mythbusting