High-risk mom worried about delivery

Dear Dr. Mitchell,

I am pregnant with my fifth child and thought I would be doing my fifth C-section. However, no doctor wants to deliver me, as they have said that I'm high risk. How am I supposed to get this baby out? I am 15 weeks pregnant.

Congratulations on your pregnancy. I know it is your fifth, and that you will need a Caesarean section for the delivery.

The problem that could arise with the fact that you have had four previous pregnancies is that the scar on the uterus gets progressively weaker with each operation that you do and the uterus can rupture at anytime in the pregnancy. The risk becomes greater if you are in the last few weeks of pregnancy before delivery and even greater if you go into premature labour. It is important that you register to have your baby at a hospital that has a blood bank or ready access to blood products. It is also important that the hospital is equipped to do an emergency Caesarean section immediately, if you go into labour before the scheduled date.

It is important that you attend all your antenatal visits, and take your prenatal vitamins and iron supplements to ensure that your blood count is good. You should also follow the advice that your doctor gives you.

It is important to drink a lot of fluids to stay well hydrated since premature contractions and labour can be triggered by dehydration. Infection can also cause pre-term labour so you should report any sign of any abnormal vaginal discharge, fever or any viral illness so that you can be appropriately managed to reduce the risk of premature labour and uterine rupture.

Your doctor might also decide to deliver the baby at least three weeks early to reduce the chances of early labour and uterine rupture. It might also be necessary to give you some steroids to mature the lungs of the baby to reduce the risk of breathing difficulties at birth and the need for the baby to be placed on a ventilator. This is especially important if there is a threat of premature labour.

Consult your doctor and ask for a referral to a major hospital so you can get the care you will need. Ensure that you eat a healthy diet containing iron-rich foods while taking your supplements. You should take your iron tablets with water or fruit juice which will improve absorption. Do not take iron with antacid, milk or tea as this will reduce the absorption and delay the increase in your blood count which is vital to ensure proper growth and development of your baby and also reduce your risk of serious complications from blood loss at the time of your delivery. You should also consider doing a tubal ligation at the time of your Caesarean section delivery to prevent an unwanted pregnancy with all its complications.

Wishing for you a safe delivery.

Best regards.

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 Avenue, Kingston 5 or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.


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.

Dr Sharmaine Mitchell

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