Is natural birth possible with fibroids?

All Woman

Dear Dr Mitchell,

I have fibroids and I am 32 weeks pregnant. The largest one has been causing me some pain, but it's not intense. My doctor has recommended a C-section, but I'm hesitant as I've always wanted the natural birth experience. Can I still have my way and at least try naturally? What is the risk of trying to push when I have fibroids?

Uterine Fibroids are found quite commonly in black women and can grow to a considerable size in a lot of cases. It presents as a complication in pregnancy in quite a lot of women. The most common problem in early pregnancy is abdominal pain which is usually due to degenerative changes caused from an increase in size of the fibroids and a relative reduction in the blood flow to the centre of these large fibroids. Pregnancy loss in early pregnancy may also be a complication especially in most fibroids that are present inside the cavity of the uterus where the foetus and placenta are located.

Fibroids may be located in the top of the uterus (fundus), body of the uterus, or lower down close to the cervix near the urinary bladder. Depending on where the fibroids are located, then they may cause a problem with space for the foetus as the pregnancy progresses. The foetus may then adopt an abnormal lie and may turn across or in an oblique lie. This poses a great problem for delivery since a vaginal delivery is then impossible. If a woman goes into labour with an oblique or transverse lie the uterus can rupture and the umbilical cord can fall out through the cervix once the amniotic sac that surrounds the foetus ruptures. This can result in the death of the foetus even when delivery is expedited by an emergency Caesarean section. Fibroids can also cause the foetus to present in a breech presentation. This means that the buttocks and feet are present in the lower part of the uterus. This would warrant a Caesarean section to reduce complications to the foetus.

If you have fibroids in the lower part of the uterus above the cervix it can block or prevent the baby from going down into the pelvis. The head of the foetus would then be higher in the abdomen. A vaginal delivery would be dangerous in this situation since the umbilical cord can slip through the cervix when the amniotic sac ruptures, resulting in death of the foetus. It is always wise to be guided by your doctor who will advise you on what is safe for both yourself and your baby.

It is extremely unwise to take risks. Uterine fibroids tend to be associated with excessive bleeding at delivery so it is advised that you eat foods rich in iron and take additional iron supplements with your regular prenatal vitamins to reduce the risk of excessive blood loss at the time of delivery. Your partner and other family members should donate blood at the blood bank for you to ensure that there is adequate reservation of blood for delivery in the event that you have excessive bleeding at the time of delivery.

Be guided by your doctor and always do what is considered safe and low risk for both you and your baby, and do the Caesarean section.

Best wishes for a safe delivery and a healthy baby.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.

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