(bouncy music)
- Babies with spina bifida
require specialized care
after delivery due to the fact
that their spine is open and exposed.
Thus when discussing delivery,
we recommend that women deliver their baby
in an institution that can provide
the multidisciplinary care the
baby will need after birth,
including the expertise of the
neonatal intensive care unit,
as well as pediatric neurosurgery.
The baby will require support
in the immediate newborn period
and surgery within the
first few days of life.
Thus we think it is best
for both baby and mother
to be delivered at the same institution
where surgery will be performed.
Babies who have spina bifida
are at an increased risk
for being in the breach presentation,
where the baby's head is not
the presenting fetal part
in the mother's uterus.
Current recommendations
for safest outcomes
for both mom and baby
when the baby's in the breach presentation
include performing a caesarian delivery.
However there continues
to remain controversy
regarding the optimal route of delivery
for babies who are head down
or in the vertex presentation
at the time of delivery in
the setting of spina bifida.
Currently there's no evidence
suggesting improved outcomes
in babies with spina bifida
born via caesarian delivery.
Therefore we carefully
consult with each mother
about her health and that of the baby.
In doing so we review the pros and cons
of caesarian delivery and vaginal delivery
and we individualize a management plan
with a multidisciplinary team.
However women who have
undergone in-utero therapy
for spina bifida require
a caesarian delivery
for that particular pregnancy.
Additionally caesarian
delivery is recommended
for all subsequent pregnancies as well.
