Thursday, March 24, 2011

The "necessary" cesarean

I am so sick of listening to people talk about how they needed a c-section.  Every time you try to have a discussion about the over use of cesarean sections in this country, you will get women adamantly defending the fact that their cesarean was of course one of the necessary ones.  For whatever reason they give, they all have some explanation for why they had to have one.

Now let me just start off by admitting that I do believe a small number of c-sections are not only necessary, but save lives.  I am not crazy, I know there are cases out there where a c-section was very necessary.  But that being said, they are being grossly overused and even caused by irresponsible choices made by both doctors and patients.

The United States has one of the highest rates of maternal death (death of the mother after birth) with 40 other countries having better survival rates for mothers.  Not surprisingly, the highest cases of death are in women that have had cesarean sections, a major surgery that greatly increases the odds of experiencing infections as well as fatal hemorrhaging and blood clots.

The c-section rate in this country is now 32.9%.  That means that 1 in 3 women that give birth in the United States do so by having the baby cut out of them.  The World Health Organization recommends that the rate of cesarean sections in developed countries should fall between 10-15% of all births.  That means that the US performs at least 2 to 3 times the number of recommended c-sections with some hospitals, doctors and areas having over 50% rates!

So why are so many women having c-sections?  The cold hard reality of the matter is that most c-sections not only could have been avoided, but were probably caused by the choices the mother made or allowed to be made for her.  Yes, at the risk of pissing off a lot of women, I am saying that I believe you may have actually caused your c-section to be “necessary”.

Think I’m wrong?  Prove it to me.  If you can read this and you don’t fall into at least one of these categories and made at least some of these classic mistakes, then you might actually be one of the 10-15% of women that “should” have had a c-section.

Here are some of the classic reasons women give as to why their cesarean section “necessary”:

My baby was too big.
Wrong.  I am so sick of hearing doctors and women telling other people that their hips are too small or their baby is too big for vaginal birth.  Tiny women all over this world give birth to large babies.  This is not the 19th century where malnutrition, rickets, and polio are causing women to have malformed pubic bones.

The reality is that women and doctors are making choices that make it harder for babies to fit through the birth canal.  A semi reclined position where a mother is sitting on her coccyx, one frequently taken while in the pushing stage when baby’s head needs to most room to maneuver through the birth canal, does not allow the pelvic to open naturally and is a huge factor in how wide the pelvic is.  Squatting can actually widen the pelvic opening by 30%!

Also, in cases of a big baby, women are often encouraged to induce as to not allow the baby to gain any more weight.  Not only does the American College of Obstetricians and Gynecologists (ACOG) not recommend inducing a baby because it is suspected to be a large or macrosomic, studies show that induction for this reason does not lead to better outcomes for the baby and also nearly doubles the risk of having a cesarean section.

My labor stalled/I had failure to progress.
Translation, my body wasn’t ready to deliver.  Often this is because the mother was induced for some reason or another without understanding the risks involved.  We may be able to artificially start labor, but we can’t always make the body fully cooperate.

Dr. Sears has this to say about failure to progress:
“Most cases, though, are due to inadequate support for the laboring woman and violation of the basic physiology of labor. Of all the reasons for a cesarean, "failure to progress" is the most under your control. No other system in your body "fails" 25 percent of the time. Why should your "delivery" system? Emotional and physical support for the mother, walking during labor, upright pushing, along with the prudent use of medication and technology will help labor progress by increasing the efficiency of uterine contractions rather than interfering with them.”
Some “failure to progress” isn’t a failure at all and is actually just a natural part of labor called the natural alignment plateau, or N.A.P.  This lack of dilation we see during a N.A.P. does not mean the labor stalled at all, but that the mother’s body is actually allowing something else to happen.  Sometimes the mother needs rest or calories, but a woman’s body will also stop dilating to allow the baby to get into a better position or slow things down if that baby needs that so they don’t get stressed.  If you give yourself and your baby some time, you will start dilating as soon as you and your baby are ready.

But what usually happens once you get labeled with “failure to progress” is that steps are taken to force things to move along at a more acceptable rate.  Usually this involves breaking the bag of water or giving Pitocin.  Speeding things up is exactly the wrong thing to do when your body is trying to slow things down.  The baby can get stuck if they were in a bad position and needed to move, or they become stressed by the stronger unnatural contractions brought on artificially when the mother’s body was trying to allow the baby to rest.  Which brings me to the next one…

My baby was in distress.
Well of course they were!  When we force a baby to endure labor before they were ready, or we cause unnaturally strong contractions using Pitocin and other drugs, they are going to become stressed!

The contractions caused by Pitocin differ from the way a uterus naturally contracts.  Contractions from Pitocin are stronger and more stressful on the baby.  You don’t get the slow, gradual buildup like with a natural contraction, and it causes the uterus to contract all at once squeezing from all sides instead of gently pushing the baby down into the birth canal.  This causes the baby to have a much harder time coping and recovering from the contractions and can cause the oxygen levels to drop sending the baby into distress.  This is why you much have electronic fetal monitoring of the baby at all times when on Pitocin.

We frequently cause our babies to go into distress when we do not allow labor to progress at the natural pace set by the mother and baby.

The cord was around the baby’s neck.
I just had to throw this one in there because I heard it just the other day and I couldn’t help but actually roll my eyes.  I am not trying to offend anyone, but this was just the icing on a very frustrating conversation about birth where another baby had to be saved via c-section for completely “necessary” reasons!

So because the cord being around the baby’s neck just sounds so incredibly frightening, let me start off by saying that one in three babies have a cord wrapped around the neck at birth.  This is not dangerous at all and very, very common.  Babies are born every day with cords around their neck and the doctor or midwife simply unwraps it once the head is out.  There are extremely rare cases where it can be an issue for some babies, but chances are, it was not dangerous for your baby.

I had a c-section last time and I think it’s just better to have another one.
If you don’t want to bother educating yourself about the risks to you and your baby and the many reasons why you might want to at least try to avoid another c-section, then that is probably why you had one in the first place.

I know that is harsh, but it is time to accept responsibility.  Too many women hand over control to doctors and other people to make their decisions for them so that they don’t have to take responsibility for their choices.  So many people spend more time researching what camera or car they should buy and don’t bother to find out anything about birth.  Well guess what, there is a really good chance that your choice to not educate yourself and make blind decisions is exactly what got you into that operating room.  You can tell me all the reasons you want as to why you needed a c-section, but the reality is that there were probably choices made along the way that caused the exact “emergency” that led to your c-section.

So now what?
Now that you know that some c-sections can be avoided, what do you do?  Here’s a few simple suggestions.  They may not prevent every c-section, but you are a lot less likely to end up in a position to need a c-section if you just do these simple things.

Educate yourself.
This is probably the most important advice I can give you.  Educate yourself.  Educate yourself about labor, birth, and what to expect.  Educate yourself about the way medical procedures and technology can help when used properly to aid labor when necessary or harm when misused and allowed to interfere with the birth process.  Educate yourself about the risks and side effects of commonly used procedures since most doctors do not thoroughly explain them.

There are many, many resources out there.  Read books.  Take a birth class like Bradley or Brio.  Knowledge is a powerful tool in the birth process.

Hire a doula.
A doula is a support person that is there to help a mother during the labor and birth process.  The emotional and physical support a woman can give another is invaluable.  It’s extremely helpful to have a person ready to back you up physically and emotionally while adding their vast knowledge and experience to help you through labor.  Generally speaking, women that have doulas present at their birth have a lower rate of interventions, including the need for pain medication, Pitocin, vacuum or forceps extraction, and a lower occurrence of cesarean sections.

Don’t get induced.
Induction is frequently done by breaking the bag of water or using other powerful drugs to interfere with the body’s natural progression into labor by causing or trying to speed it up.

Being induced increases the odds that your baby will experience fetal distress, abnormal heart rate, shoulder dystocia, and need to be admitted to the NICU.  It also increased the odds that a vacuum or forceps will be used to deliver your baby.  If that is not enough reason to avoid being induced, recently, a study found that being induced more than doubles your chance of having a c-section.  Woman who are induced are twice as likely to need a c-section as women that are not.  (click here find out more about the study)

Women are often forced to stay in bed because of all the equipment they are plugged into.  They don’t always force you flat on your back anymore, but they still don’t want you walking around or crouching on your knees, especially once labor progresses.  Being free to move around helps during both the labor and the birth.  Labors progress better when the mother can move and movement is an important part of coping with the contractions.  Baby also has more room to fit and maneuver through the birth canal when you are not confined to a bed while sitting on your coccyx.  If you must be in bed, try to at least kneel, crouch, or lie on your side to allow for a more open pelvis.

And finally…
Trust your body.
When we interfere with the natural progression of labor, we are asking for trouble.  A woman’s body is designed to give birth.  It knows when to start labor, when to slow it down, and when to move.  Unfortunately, women are taught not to trust their bodies and allow doctors, nurses, and machines tell them what they should be doing.

Moral of the story…

Take responsibility.  No one is telling you that you need have to have an unmedicated birth.  No one is telling you that you can’t have Pitocin or even an elective cesarean section if that is what you want.  But it’s time to stop acting like a victim.

Sometimes there are cases where there is absolutely nothing anybody could have done to change the outcome of a birth.  But more often then not, the choices you do or don’t make will affect your birth.  If you refuse to acknowledge that you can greatly influence the outcome of your birth, then at the very least, stop telling people that you had to have a cesarean section, not because I think you are wrong, but for every pregnant woman or future mother within hearing distance.

With the c-section rate in this country being so high, one in three birth stories a woman will hear is going to be a cesarean, even more in some crowds.  Every time you tell some pregnant woman about how you had to have a c-section because your hips were too small or you just never fully dilated, you are perpetuating the myth that women need all the medical help they can get to deliver their baby.  You are planting seeds of doubt in the ability of women to birth their baby naturally.

On a positive note, I know many women that have had two, three, and even more babies, all vaginally, many very big, and without any complication or need for major interventions.  This is just more evidence that if you educate yourself and can avoid having a c-section the first time around, you greatly decrease the odds that you will end up with one in the future.  By making choices that reduce your risks, you can repeatedly avoid being that 1 in 3 women that ends up with a cesarean.  And if you do end up needing one, at least you’ll know you did what you could to avoid one.

Articles, Referances and Resources:

Dr Sears:

Childbirth Connection: Cesarean Section

The Avoid an unnecesarean

DONA International: Doula FAQ


The Birth Book: Everything You Need to Know to Have a Safe and Satisfying Birth by Dr. Sears

Birthing from Within: An Extra-Ordinary Guide to Childbirth by Pam England

Gentle Birth Choices by Barbara Harper

The Complete Book of Pregnancy and Childbirth by Sheila Kitzinger

Ina May's Guide to Childbirth by Ina May Gaskin

1 comment:

  1. Oh honey, I wish I could say that my c-section was necessary, but I'm not sure. I read everything and was the biggest natural childbirth advocate you would find. I labored naturally to 9cm and then stayed there for hours - and I had a doula helping me out. I wrote out my entire birth story here: I don't know though whether the section could have been avoided and I think I will never know. I am mourning not being able to birth my child naturally and it pains me every time I think about it.

    By the way I just came across your blog today and am really enjoying it. I thought I'd comment on this post since the memory of my section a mere 2.5 months ago is still raw and I don't know what category I fit into.