Under certain circumstances, Cesarean Sections can be the safest option for baby & mama. It’s a surgical procedure opening your abdomen & uterus to remove your baby.
An anesthesiologist or nurse anesthetist numbs your lower body. Then an OB makes a cut through your lower belly skin, tissue, abdominal wall & into your uterus. With the uterus open, the OB can pull out your baby & remove your placenta. After stitching up your uterus, they’ll stich up (or staple) your skin. (Learn what an OB (who’s a mom) wants you to know about C-Sections here)
Recovery takes longer & is usually significantly more painful than vaginal births. For example, it’s not uncommon for vaginal birthing women to be up and about, holding their baby, while C-Section delivery mamas typically need a wee bit extra help for a few weeks, doing things like: driving, getting up, sitting up, picking things up (and doing laundry- or any other chore you dislike;).
Why C-Sections Happen: Urgent, Unplanned & Scheduled
1. Urgent- in a very small number of pregnancies or labors, reasons for urgent c-section include baby not getting enough oxygen, umbilical cord prolapse (that’s when the umbilical cord makes it’s way out before baby does), mom bleeding. In urgent situations like these, emergency C-Sections can and do save lives.
2. Unplanned- something happens during labor which requires a c-section, but it’s not an urgent situation. Often times you’ll hear the words “failure to progress” associated with unplanned c-sections which means that your labor isn’t progressing as quickly as hospital protocol dictates is acceptable.
3. Scheduled- your provider may recommend a C-Section for several reasons concerning your or your baby’s health. A few of the most common are:
- You had a previous C-Section
- Baby is Breech (and attempts to turn baby didn’t work)
- You’re having multiples (they’re not in optimal position)
- Your placenta is blocking the baby’s way out of the vadge (that’s called placenta previa)
- Changes in baby’s heart rate.
With a scheduled C-Section, you’ll not go into labor. You’ll set a date & time to drive to the hospital & have the C-Section surgery. Some women choose planned C-Sections in these scenarios and others don’t.
Your research, your relationship with your provider and your values play into these planned C-Sections, because not all are medically required. Before you settle on a provider, having an honest conversation on how, when & why they recommend C-Sections is a really really good idea. Some providers will strongly encourage a C-Section much sooner than others & before there is a real medical need. A C-Section significantly influences future pregnancies & births. We explain why below.
*Also note there are several Non-Medical reasons women want C-Sections:
- Concerns about Pelvic Floor Challenges
- Severe Fear of Birth.
Making an informed decision on the trade-offs is important.
Risks of Cesarean Birth
C-sections have become safer than they once were, but are still major surgery. The risks & potential complications for mom & baby are greater than for vaginal births. C-Sections also increase the risk for future pregnancies & births.
Risks to mom:
- More intense & longer lasting pain
- Slower recovery- more difficulty getting around due to severity of pain at wound
- Greater chance of Infection & Injuries (evidence says 5-20 times infection risk)
- More blood loss & greater risk of blood clots
- Longer stay in hospital
- Less early contact with baby- less likely to hold & see baby after birth than vaginal birth
- Higher risk for after birth fear & anxiety (post-traumatic stress disorder- PTSD)
- Hysterectomy- more likely to have uterus removed than a vaginal birth
- Risk of death- risk is very small, but 5 times higher than vaginal birth
- Re-admission to hospital- for complications from surgery
Risks to baby:
- More likely to have breathing problems (because baby’s lungs are often not fully developed & because during normal labor, the baby’s body produces sodium chloride which extracts the fluid out of the lungs in preparation for breathing air)
- More likely to have breastfeeding problems (because the interplay between the mom’s & baby’s hormones does not happen with the same intensity or the same way, which is what kicks off breastfeeding)
- Accidental surgical cuts (risk is minimal, but does happen)
- Moderately higher risk of Asthma than for vaginally born babies (Evidence from the U.S. National Library of Medicine & National Institute of Health here & here)
Risks for future pregnancies:
- Placenta problems- where & how it attaches to the uterine wall (placenta accrete, placenta previa or placenta abruption)
- Uterine rupture
- Ectopic pregnancy
- Risk of death- still very low, but risks are higher when a woman had a uterus with cesarean scar
The C-Section rate in the U.S. in 1970 was 5%. The C-Section rate today is over 32%. The World Health Organization recommends C-Section rates should not be higher than 10%-15%. Are 32% of American women’s bodies really incapable of birthing normally & require major surgery to become moms? We don’t know the medical answer, but that just sounds awful high doesn’t it?
How can I decrease the chance of having a C-Section?
- If there is no emergency, ask your provider “Why are you recommending this & what does the evidence say?”
- Ask what other options you have (waiting longer, moving around during labor, if baby is breech have a skilled caregiver turn baby)?
- Communicate you want no interventions without a medical reason (Continuous Electronic Fetal Monitoring, Induction, Epidural, etc), because they can lead to a “significant increase in C-Sections” (Evidence here from a study of 13,000 women).
- Have continuous support (family, doula, coach), because it’s proven to decrease interventions, which can lead to C-Sections.
- Each hospital & Provider has the rate at which they perform C-Sections- “their C-Section rate”. Ask “What is your c-section rate?”. Midwives can’t actually perform C-Sections, but still ask what their rate of C-Sections are because the care leading up to the C-Section is what defines the C-Section rate. The takeaway… if they have a high c-section rate, expect to have a c-section. For example-If you’re shooting for a Vaginal Birth, then going to a hospital or provider with a 40% C-Section rate probably isn’t the best choice (there are hospitals with c-section rates under 10%).
C-Sections are an amazing life-saving procedure when medically required. When not medically required, they expose you & your baby to unnecessary risk. Many providers treat C-Sections like they’re just a routine, no big deal, procedure. The fact is they are major surgery & have implications for you, your baby & all future babies. Bottom line, by asking a few easy questions NOW you’ll quickly get a snapshot & gut feeling of who’ll get behind you & support your goals. And just as important…who won’t.
If you find yourself unexpectedly in the position of a c-section- you still have some control & options. Here are some ideas:
- Ask for your spouse and Doula (or birth support) to be in the Operating Room with you. Birth support to help you relax is still essential and effective. Plus your doula can take pics of you, your spouse and your sweet baby.
- Ask for the ambiance you want- i.e. specific music to be playing, lights not needed for procedure to be dimmed etc. If there’s an aroma you prefer (like lavender, ask for some of that to be placed near you to help you relax).
- Ask for the baby to be placed on your chest immediately after birth. Request your arms be untied so you can hold baby on your chest or at least have your spouse nearby to hold baby as close to you as possible (even if staff *must* attend to baby, you can have them work with baby near you- ask for it! Baby doesn’t have to be weighed & all that jazz right away if you don’t want them to be. Know what you want mama…this is your birth!).
- Ask for baby to stay with you the entire time.
- Ask spouse to accompany baby wherever they go (if they insist on separating you).
- Ask to breastfeed ASAP- your doula or spouse can help you if you feel shaky or tired. The first hour of life for newborn/mama bonding is super important & breastfeeding is part of that. The ‘bonding’ isn’t just a feel good thing, there’s a whole lot of science happening (hormones, etc.) that helps baby feel safe & develop during their transition in to their new world.
Not all doctors or hospitals will say “yes yes yes!” to each of these suggestions, but it’s worth asking. It’s your birth!
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