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Once a C-section, Always a C-section?

By Mark Schemmel, M.D.

Patients often ask if having had a cesarean once means that they will always require a cesarean.  The fact is that most women who have had a single prior cesarean are candidates for what we call TOLAC, or a trial of labor after cesarean. Many of these women have a high likelihood, 60-70% or better, of succeeding in achieving a VBAC (vaginal birth after cesarean). Individual likelihood of success is variable depending on a number of factors. This can be determined through consultation with your obstetrician as part of an overall discussion of the pros and cons of TOLAC.

When discussing chances of vaginal deliver after cesarean, your doctor will consider the reasons for having had a prior cesarean as well as medical conditions and disorders, gestational diabetes, and current pregnancy complications.  There is always a risk associated in attempting a vaginal delivery after cesarean.  Risks to the mother include having another unsuccessful labor leading to repeat cesarean.  Risk to the baby (and mother) include uterine rupture.

Your obstetrician will assist you in consider all of this information and deciding whether or not TOLAC is the best choice for you.

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Dietary Supplements During Pregnancy

By Dr. Jason Reuter

It is important to maintain healthy nutrition during pregnancy.  Taking the time to meal plan and shop for healthy food is essential.  In addition to obtaining nutrition from food, some women turn to nutritional supplements to maintain good health during pregnancy.  Nutritional supplements are intended to aid in acquiring nutrients lacking from food consumption, or that are in extra demand due to the pregnancy.  However, controversy and confusion exist when it comes to the safety, type, and quantity of nutritional supplements.

In general, there are two categories of nutritional supplements: (1) elemental supplements, or vitamins; and (2) herbal or plant supplements.  Each of these categories is addressed in turn below.

Elemental Supplements found in Prenatal Vitamins

Elemental supplements, also referred to as vitamins, play an important role in the health of the mother and development of the fetus.  Elemental supplements have been well studied for decades and have undergone rigid and comprehensive safety studies to determine the quantity that is safe for a healthy pregnancy.  As a general guideline, the safest practice is for pregnant women to take only prenatal vitamins.  Vitamins such as folic acid, calcium, iron, vitamin D, potassium and many of the “B” vitamins (thiamine, niacin and riboflavin) are found in prenatal vitamins.

Herbal or Plant Supplement Safety

Herbal or plant supplements may be regarded as “safe” by the public, but there is often no scientific data to support this.  While elemental supplements are purified and the dosing range is established, the same is not true for herbal or plant supplements.  Herbal or plant supplements are sold in many different preparations by many different companies.  As a result, they are sold without prior testing and their makers have no obligation to report adverse events.  The lack of oversight of the herbal supplement market allows companies to make inaccurate and/or false claims of the reported benefits of the supplements without recourse.

Another concern for pregnant woman is many manufacturers of herbal supplements use fillers and unlisted ingredients, such as metals, to decrease their cost of production.

The lack of prior testing of herbal supplements is concerning for pregnant women, because the risks are simply unknown.  A lack of proof of harm should not lead a pregnant woman to assume herbal supplements are safe.  Due to the unknown safety of herbal or plant supplements, it is standard practice to recommend that women avoid taking herbal supplements during pregnancy.

Discuss all nutritional supplements with your medical provider

Please note this posting is not meant to be a comprehensive discussion, but rather, a starting point for further discussion with your medical provider.  In addition to the nutritional supplements discussed above, two other items to be discussed with your medical provider include caffeine and omega 3 supplements.  These items are beyond the scope of this article, but a pregnancy woman should be aware these may pose a concern during her pregnancy, should she choose to use them.