Cesarean Birth

c-sectionA cesarean birth is a form of abdominal surgery.

Still a miracle, still a birth.

For the small percentage of mothers and babies who really need cesarean birth, we applaud your courage.
Well done, brave mother.

No one should be made to feel she failed or is inadequate, because her baby was born via cesarean birth.

This mother DID give birth. Perhaps it was not the birth a particular mother dreamed of and planned… yet, it was a birth, a miracle.

If you had a cesarean birth you feel was unnecessary, love is the healing answer, the only answer.

Stacie Hunt, CPM-TN and midwife on The Farm is the mother of five children; a hospital birth, a home birth, two c-sections and a VBAC at home. She has two grandsons, both born at home, Stacie had this to say about her two Cesarean births, “It was OK, I knew I needed them and I am fine. I went on to have a VBAC with my last birth. I do not feel traumatized. I healed afterward and I have 5 healthy children. ”

About Cesarean Birth

During a cesarean birth, the baby is removed from the mother through an incision in her abdomen and through the wall of the uterus. This procedure is called for in emergency situations where the health of the mother and or baby are deemed to be at risk.
Wisely used, when truly needed, cesarean birth saves lives. However for a variety of reasons, the number of women receiving c-sections has been rising dramatically, raising the question of why so many women are now unable to give birth vaginally?

When statistics were first collected in 1965, the number of cesareans being performed in the U.S. was at 4.5%. By 2014, that number had grown to 33%, meaning one in three  mothers in U.S. have their babies delivered by cesarean, and in many hospitals, for a large number of doctors, and in numerous other countries, the numbers are climbing much higher. It has even become socially acceptable to choose the cesarean as an alternative to vaginal birth.

Risks

All major surgeries carry risks.
Complications and risks associated with cesareans include:

  • Hospital acquired infections such as MERSA and CDIF.
  • Pulmonary embolism
  • Postpartum hemorrhage and damage to blood vessels
  • Anesthetic accidents
  • Significant disruption with bonding and breastfeeding during the immediate postpartum with baby.
  • Babies born by cesarean do not receive proper exposure to mother’s healthy flora, to establish optimal health.
  • A significantly longer and more painful amount of time is required for the mother’s recovery and healing.
  • Over $20,000 more in cost than a normal, vaginal delivery, a considerable hardship for families.
  • Cesarean born babies are more likely to require NICU care.

Although it is possible after a cesarean for a mother to  deliver future babies vaginally, many physicians are reluctant to perform the VBAC (Vaginal Birth After Cesarean), citing a weakness in the uterine wall that could lead to rupture and hemorrhage.

This means that for many mothers, they enter a cycle of repeated abdominal surgeries. It becomes especially important for first time mothers to take steps during pregnancy to prevent the necessity of a cesarean whenever possible.

Factors Leading to a Cesarean Section

Prevention of The Primary Cesarean Section

“With the increase in cesarean rates over the last few years, the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine issued a joint Obstetric Care Consensus statement on the Safe Prevention of the Primary Cesarean Section. This statement provides fantastic guidelines in the way maternity care should be delivered and in the way hospitals and doctors should look at progression of labor, electronic fetal monitoring, breech presentations and twin pregnancies. All of this is done in an effort to reduce that primary cesarean!” Vijaya Krishnan

A Sedentary Lifestyle

Quite often medical problems that can lead to a cesarean birth are the result of a sedentary lifestyle.
For example, a sedentary lifestyle combined with an unhealthy diet can lead to:

  • Obesity
  • Gestational Diabetes
  • High Blood Pressure and pre-eclampsia
  • A large baby, over the ideal birth weight, which can be more difficult to push out. (a large baby does not automatically indicate the need for cesarean birth)

Lack of exercise can also result in limited stamina. The “labor” of birth can be physically challenging. For women who have never engaged in physical labor or other physically demanding activities, the amount of endurance required by the birth process may be more than they are prepared for.

In addition to the medical issues, there are also a variety of other causes that may lead to a cesarean section.

Lack of Sleep

If labor fails to progress quickly, coupled with a lack of sleep due to early, light labor contractions that go on through one or two consecutive nights, a women can find herself exhausted during the final stages of labor that require her to summon an extra burst of energy. This often happens to first time mothers who feel the initial contractions and believe that they have started labor. Excited and anxious, they are unable to sleep, only to find the next day they have a long way to go. Sometimes laboring mothers who are exhausted, and simply need comfort measures and help resting, are easily pushed into having a cesarean birth.

The Setting

The environment of the hospital with its many beeps and alarms, the buzz of activity from nurses and other patients, does not promote relaxation or encourage the opening of the cervix. Oxytocin, the love hormone, is the gas that fuels labor and birth. The flow of oxytocin within the mother’s system is impaired if she feels, disturbed, watched, judged, chilled or unsupported in any way.  Mothers in labor are often left on their own, with only an inexperienced partner or family member, who has few if any skills to support childbirth. Having your own doula or labor coach and/or midwife, can greatly help mothers persevere, through the sometimes challenging final stage of labor, to a successful natural delivery.

Labor nurses do their best to help, but they have many responsibilities and demands on their time, and may be providing care to several mothers simultaneously. The mother in labor may be meeting the nurses for the first time, and time is needed to establish a bond of trust.  Under the care of a midwife, this bond has been nurtured during pregnancy, and deepens during labor and birth.

The Cascade Effect

Upon checking into the hospital, women are often wired up to a fetal heart monitor and connected to an IV. This prevents the mother from being able to walk or comfortably change positions, both of which assist in the progression of labor during natural childbirth.

The physician “strip the membrane” inside the mother’s cervix, or may break the baby’s water bag, which sometimes helps labor to progress more quickly. Sometimes breaking the baby’s water causes fetal distress.

Unfortunately this also puts the delivery on a timeline. Once the water bag is broken, the baby is no longer in a sealed environment, meaning it is now exposed to possible infection. Most hospitals allow a woman to labor a maximum of 10 hours once the water bag is broken, before a cesarean section is mandated.

Very few hospitals are utilizing  methods such as water birth, which has been found be an effective natural method of  pain management.

Elective C-Sections

There is a startling trend of women choosing or requesting c-sections, with some doctors willing to comply, even when there is no medical indication surgery is needed, the co-called “elective” c-section.

Reason’s women are opting for an elective c-section:

  • A firm date for childbirth
  • The ability to schedule for maternity leave
  • To avoid the pain associated with natural childbirth
  • Faster delivery

Resources:

Prevention of the Primary Cesarean Section: Facts, Myths and Tips
by Vijaya Krishnan to read an expert:https://www.midwiferytoday.com/articles/cesarean_prevention.asp to read the whole article go to Midwifery Today Summer 2016 issue 118

American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine issued a joint Obstetric Care Consensus statement on the Safe Prevention of the Primary Cesarean Section.  http://www.acog.org/Resources-And-Publications/Obstetric-Care-Consensus-Series/Safe-Prevention-of-the-Primary-Cesarean-Delivery

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