Choosing a Vaginal Birth After Cesarean

During a vaginal birth after cesarean, or VBAC, a baby is delivered through the vagina of a woman who has previously had a cesarean section. During a cesarean, an incision is made through the abdomen and uterus of the mother and the baby is delivered through this opening. Women who have previously had cesareans may opt for vaginal births in subsequent pregnancies, says OB/GYN Steven C. Goldberg, M.D., FACOG.

New Jersey’s cesarean rate typically ranks among the top four in the United States. In 2003, the cesarean rate in New Jersey was 33.1 percent, 20 percent above the national average (26.5%). Despite the high cesarean rate, there are benefits to planning for a vaginal birth, either for a first baby or following cesarean.

Raritan Bay Medical Center has one of the lower cesarean rates among central New Jersey hospitals.

“Six or seven out of 10 women can successfully achieve a VBAC delivery, and there are definite benefits,” says Dr. Goldberg, who serves on a task force sponsored by the New Jersey Hospital Association whose goal is to educate women and physicians about VBAC deliveries. “One of the most important benefits is a faster recovery. You can go home sooner after a vaginal delivery. Assuming the patient who is having a VBAC already has a child, that woman can return home to her child, to her family, and be back on her feet much more quickly than someone who experiences a cesarean, which requires a longer hospitalization and recovery period.”

Additional benefits of a VBAC include a decreased risk of infection and injury to body organs, less blood loss, and a decreased risk of blood clots, too. Dr. Goldberg also stresses the emotional aspects of vaginal birth. “Having a vaginal birth gives women an active part in the labor and delivery of their baby,” he adds. “More people, such as family and close friends, may be allowed in the delivery room with you while you have your baby. Some women feel that having a vaginal birth is the more natural way to have a baby.”

There are factors to consider before planning a VBAC delivery and some indicators of whether or not a woman can achieve a successful VBAC. Your physician must learn where the cut was made in your uterus during your cesarean. If the incision was made through the lower part of your uterus, you may have a greater chance of having a successful vaginal delivery. If you have had no other surgery done on your uterus and if your pregnancy is normal, your chance of successful vaginal birth may be higher. If you have had babies one or more times vaginally, before this pregnancy, your chance of success increases. If your labor begins on its own, without being induced, you have a greater chance of having a successful vaginal birth. Infections such as genital herpes or problems with your pregnancy may decrease your ability to give birth vaginally.

VBAC’s also have risks associated with them. In rare instances, your previous cesarean scar may rupture, causing internal bleeding and placing both mother and baby at risk. You may try to have your baby vaginally, but the birth may not go as planned. If this happens, you may need to have an urgent cesarean. Other factors may also decrease the chances of having a successful vaginal birth after cesarean, says Dr. Goldberg. “If you have had more than one cesarean in the past, your chances of delivering your baby vaginally decrease.”

Dr. Goldberg notes that having a very large baby, or if your pregnancy has gone past the date that your baby was to be born – more than 40 weeks, may mean you cannot be able to deliver vaginally. If your unborn baby is in breech position, this also negates your chance of having a vaginal birth.

Lifestyle issues such as being overweight, smoking, and alcohol use can also influence your ability to successfully delivery vaginally after cesarean.

If a woman is interested in a VBAC delivery, Dr. Goldberg recommends that she and her doctor discuss all of these issues thoroughly. “Women should learn as much as they can about having a VBAC,” says Dr. Goldberg. “They should talk to other women who have had a VBAC, and they should prepare a list of questions to ask their physician. Their physician should inform them of all of the benefits and risks, and encourage them to raise any questions or concerns.”

Dr. Goldberg also suggests that women planning a VBAC should pay extra attention to their diet and exercise, and take childbirth classes to help them understand what to expect during labor and vaginal delivery.

“Conditions for a VBAC have to be just right for the well being of both mother and baby,” says Dr. Goldberg. “When we help a mom achieve a VBAC delivery, we feel good. There’s always satisfaction for the physician and delivery team when we help a patient accomplish something they really want to accomplish.”

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On August 19th, 2011, posted in: News by

Getting Ready To Have a Baby?

“What you do before pregnancy can help you and your baby have a healthy pregnancy,” says Steven R. Berkman, M.D., FACOG, FACS. “Talk with your doctor about any issues or concerns. It’s important that you and your OB/GYN have an open and frank rapport as you journey through the next several months together.” Dr. Berkman says that one of the most important steps a mother-to-be can take is to see her physician before she conceives. “About half of pregnancies in the U.S. are unplanned,” says Dr. Berkman, “making pre-conceptual counseling sometimes difficult. But this can be a really important first step for a healthy pregnancy and a healthy new baby.”

11 Steps to a Healthy Pregnancy

1. Take folic acid at least a month before conception.

Take a multivitamin with 400 micrograms of folic acid every day to help your baby’s brain and spinal cord develop properly. Eat foods that contain folate, including fortified breads and breakfast cereals, beans, leafy green vegetables and orange juice.

2. Get a checkup before pregnancy to evaluate your health and identify health and lifestyle risks that may affect your pregnancy.

See your dentist. If there’s any chance you may be pregnant, wait until after the baby is born to have dental x-rays. Discuss all medications you are taking with your physician, and make sure your immunizations are up to date.

3. Eat right and maintain a healthy weight.

You’ll feel better and start your pregnancy off right if you eat a variety of nutritious foods every day. Avoid foods high in fat and sugar. Eat foods from each of the five food groups: fruits, vegetables, proteins (like chicken, fish and dried beans), grains, and milk products. Moderate amounts of caffeine per day appear to be safe during pregnancy. Remember, caffeine can be found in coffee, teas, soft drinks, medications and other foods. Try decaffeinated beverages, or drink water, milk or juice to avoid excessive caffeine intake.

4. Try to reach a healthy weight before you get pregnant.

If you’re overweight or underweight, it may be easier to get pregnant if you get to a healthy weight. It’s not safe to try to lose weight once you’re pregnant. If you have diabetes, make sure your diabetes is under excellent control before you get pregnant.

5. Stop smoking and avoid secondhand smoke.

Smoking may make it harder for you to get pregnant. If you smoke, your baby is at greater risk for being born prematurely or too small. Smoking during pregnancy increases the risk of pregnancy complications and SIDS (sudden infant death syndrome). If you need help, ask your health care provider for advice.

6. Stop drinking alcohol.

Drinking alcohol can make it harder for you to get pregnant. Drinking alcohol before or during pregnancy can cause your baby to have conditions that can create lifelong problems like fetal alcohol syndrome, low birth weight, heart defects, growth problems and problems with brain development. If you need help to stop drinking, ask your health care provider.

7. Don’t use illegal drugs.

Taking drugs during pregnancy is risky for mother and baby. Using cocaine places you at higher risk of miscarriage and preterm labor. Babies exposed to heroin are likely to be born addicted. Babies exposed to illegal drugs also are more likely to have learning or behavioral problems. Women who use methamphetamines or marijuana may have babies that are too small. If you need help to stop, ask your physician.

8. Avoid infections.

Some infections can harm a developing baby. Wash your hands well with soap and water after using the bathroom, blowing your nose or touching soil. Avoid raw meat and fish and unpasteurized milk products. Wash all fruits and vegetables well. If you have a cat, ask someone else to change the litter box. Stay away from rodents, including pet mice, hamsters and guinea pigs. Find out if you have a sexually transmitted infection (STI). Without treatment, these infections pose special risks for pregnant women and their babies. At a preconception visit, ask your physician about screening tests for HIV or other STIs. To avoid STIs, have sex with only one person who doesn’t have any other sex partners and who doesn’t have an STI.

9. Limit exposure to hazards.

Avoid hazardous chemicals like cleaning supplies and insect killers. Stay away from strong-smelling cleansers, chemicals and paint. You may reduce your risk by wearing rubber gloves and working in a well-ventilated area. If your water pipes are old, you may want to have them tested for lead or, drink only filtered or bottled water. Ask your physician for advice about hazardous substances and chemicals.

10. Learn about genetics.

Your physician will learn your health history by asking you about the health of your family. Based on this information, your physician may recommend that you see a genetic counselor to learn about your risk of having a baby with a birth defect.

11. Avoid stress and get fit.

Too much stress may be harmful for you and your baby. High levels of stress may increase the risk of preterm labor and low birth weight. Start reducing stress now. Identify causes of stress and try to reduce them. Ask partners, family and friends for emotional support or get professional help. Use relaxation techniques, such as deep breathing. Call a hotline or ask your doctor or a trusted person for help if you’re in a relationship where you’re in danger of being harmed, whether it be verbal or physical abuse. Getting at least 30 minutes of exercise on all or most days of the week is a good way to help maintain or lose weight, build fitness and reduce stress. If you aren’t already exercising, now is a good time to start. Talk to your physician about fitness activities that are right for you. Some good choices before and during pregnancy include walking, swimming and yoga.

Don’t forget to help Dad get healthy, too! To improve your chances of getting pregnant, it’s important for your partner to take care of himself, exercise, eat right and stop smoking, drinking or taking illegal drugs.

“Don’t forget your partner in the quest to conceive,” suggests Dr. Berkman. “Take time to enjoy each other now. After the baby comes, it will be harder to be alone, to just be a couple once again. Enjoy these pre-pregnant times. This is the start of your journey together as a family. Make it a special trip!”

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On August 19th, 2011, posted in: News by

6 Warning Signs Women Shouldn’t Ignore

Bay Family OBGYN physicians, Seven C. Goldberg, M.D. FACOG, Steven R. Berkman, M.D., FACOG, FACS discuss the six major warning signs that often go unchecked in many women.

“Minor indicators can signal serious health issues,” says board certified OB/GYN Steven C. Goldberg, M.D., FACOG. “For many women, their OB/GYN is their only physician, so it’s important that you talk over all of your health concerns, and we can make an appropriate referral.”

“Today’s women are superwomen, always taking on everything for everyone,” says Steven R. Berkman, M.D., FACOG, FACS, a board certified OB/GYN, “but it’s important to take time for yourself, especially for these important health checks.”

1. Hello Mole. Finding a new one or seeing changes in an existing mole could signal melanoma, the deadliest type of skin cancer.

2. Tingly Toes. Tingling, burning or numbness in feet or hands can indicate pre-diabetes, which damages the nervous and circulatory systems.

3. Tummy Trouble. Bloating, pain or changes in bowel habits or rectal bleeding can indicate diverticulitis, colon or rectal cancer.

4. Heart Ache. Heart disease is the #1 killer of women. Symptoms are more subtle in women so see a doctor to avoid heart attack or stroke.

5. Breast Lumps. Know your breasts intimately. Examine monthly, and talk to your doctor about when and what kind of mammogram is best for you.

6. Tough Night. Daily fatigue can indicate sleep apnea or restless leg syndrome. Sleep disorders worsen after menopause.

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On April 21st, 2011, posted in: News by

Physician Focus: Eumena M. Divino, M.D., F.A.C.O.G.

“I love delivering babies and now I am delivering babies from babies I’ve delivered,” laughs Eumena M. Divino, M.D., F.A.C.O.G. “Recently a young pregnant patient told me that I had delivered both her mother and her father. Now, that was a first!”

Dr. Divino, an obstetrician/gynecologist, has had several firsts in her career, which spans thirty-five years. In another pioneering step, Dr. Divino was the first female OB/GYN on staff at Raritan Bay Medical Center when she joined the medical staff at the Perth Amboy Hospital in 1973. Raritan Bay Medical Center recognized Dr. Divino by honoring her as its Physician of the Year in 1995.

Obstetrics and gynecology are the two surgical specialties dealing with the female reproductive organs, and are often combined to form a single medical specialty and postgraduate training program. This combined training prepares the practicing OB/GYN to be adept at the surgical management of the entire scope of clinical pathology involving female reproductive organs, and to provide care for both pregnant and non-pregnant patients. Dr. Divino also performs gynecological surgeries such as hysterectomies and cesarean sections.

A native of the Philippines, Dr. Divino is one of ten children, mother of a son and a daughter, and doting grandmother of one. She graduated from the University of Santo Thomas in Manila and completed an externship at Silliman University in Dumaguete City before coming to the United States. Dr. Divino completed her OB/GYN residency at Charles Wilson Memorial Hospital in Johnson City, New York.

Dr. Divino is a Fellow of the American College of Obstetrics and Gynecology and is board certified by the American Board of Obstetrics and Gynecology.

She is a member of the Obstetrics-Gynecology Society of New Jersey, the Middlesex County Medical Society, the Philippine-American Medical Society, the Filipino American Society of New Jersey, and the Filipinos and Friends of Edison, NJ organization.

Her delight in her patients is palpable, even after all these years. “What I do is very meaningful to me. I am not bothered by having to get up in the middle of the night if a patient needs me. This is a profession I have really loved since the beginning and I still enjoy, so having to wake up at night is a small price to pay for doing something I love,” says Dr. Divino.

How many babies has Dr. Divino delivered? “I don’t really know for sure but on average 150 babies every year for thirty-five years – you do the math!”

Delivering babies has thankfully been a largely beautiful experience for Dr. Divino and her patients. “It’s a wonderful thing to deliver babies. It still amazes me how it happens,” she says. “Once in awhile there is a traumatic event and that is always the toughest thing for the mother and family, and even for me. Birth is supposed to be a happy event, so to lose a child or to have something traumatic occur is a nightmare for everyone. There’s a healing process that has to follow, and it’s important for the family to have counseling and support as much as possible. Life is not always perfect, sadly.”

During her career, Dr. Divino has seen trends like water births and birthing chairs come and go, and now routinely has fathers actively participating in the labor process. “It’s nice to have families in the room to support the mother but sometimes it can be too much,” says Dr. Divino. “Some women want to include even extended family and friends. But, I don’t deny them.”

Dr. Divino and her husband, a retired engineer, live in Edison where they are involved in their community and enjoy going out with friends. In her time off, Dr. Divino is an avid sports fans. “I like to watch baseball, tennis and football. I am a diehard Yankees fan and I truly wish they were doing better this season.”

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On April 21st, 2011, posted in: News by

Services

Our board certified physicians excel in a number of specialties ranging from family planning to high risk pregnancies to pre-and post-menopausal care. Having such a wide range of services allows us to care for women at each stage of their life. Read More: links to services page.

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On November 9th, 2010, posted in: Homepage by

Welcome to Hackensack Meridian Health Medical Group OB/GYN!

Whether you’re already a patient or thinking about becoming one, we welcome you to our practice! Known to many as Bay Obstetrics and Gynecology, we provide comprehensive health care for women of all ages. Serving patients since 2005, our care team has decades of combined experience and are focused on your care. We get to know you and your family, and you’ll be welcomed on every visit by our warm, attentive and caring support team.

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On November 4th, 2010, posted in: Homepage by