“A Cesarean Section Rate Over 15 Percent Does More Harm Than Good.” the World Health Organization
There are times when c-section is absolutely necessary for the safety and health of mom and/or baby.
However, the 30% cesarean section rate in the United States is double what the WHO considers safe. This means half of the cesarean sections that are performed on women today, are actually doing more harm than good – unnecessarily.
When is a Cesarean Section Necessary?
Scenarios present themselves during birth that may be (not an absolute) better resolved by c-section than vaginal birth are:
- Fetal distress
- Breech presentation
- Dystocia (not progressing)
- Repeat cesareans
- CPD (pelvic disproportion)
It’s a very, very fine line trying to discern whether a cesarean is the right choice, and most mothers, husbands, family, doctors and nurse midwives alike tend to take caution’s side.
Additional options that could be tried before a cesarean section.
A c-section should not be the first choice remedy for stalled labor.
Some of those options include walking, for a woman who is not progressing or changing positions for a baby who is in fetal distress, depending on the intensity of the situation.
CPD, although it is commonly used as a reason for c-section, is actually very rare. Try changing positions, especially to “all fours” on your hands and knees. This position opens the pelvis more than lying on one’s back.
Another tip: patience. Wait. There is no rush (unless it’s seriously medically necessary).
What Are the Risks of a Cesarean?
Mom also needs to stay in the hospital for 2-3 days to heal enough to become mobile and heal for another approximate 6 weeks before “returning to normal.”
Emotional risks include being separated from their partner during the operation (sometimes they can be present in the operating room unless it is truly an emergency situation).
If the mother is unconscious or not “with it” enough to see her newborn, the immediate separation from their baby just after birth which can (usually) turn into hours to let mom rest. The result is the complete loss of the instantaneous hormonal bonding period that takes place just after baby is born.
During those hours that mom is recovering, baby must be fed. Receiving a bottle with formula may result in nipple confusion. The breastfeeding relationship may be permanently compromised, or get it off to a tricky start.
Physical risks to baby include minor injury from the doctor while being pulled out of the uterus, breathing problems due to either early delivery and the lungs not being fully developed or excess fluids not being “squeezed” out while being pushed through the birth canal.
If the cesarean is scheduled, one runs the risk of delivering a premature baby due to inaccurate due dates.
Emotional risks are similar to mother in that the initial window for bonding is missed, as well as immediate breastfeeding to get colostrum, or “first milk,” which is rich in vitamins and provides newborns with immunity to infections.
What is a VBAC and What Are the Risks?
VBAC stands for Vaginal Birth After Cesarean.
The one main “risk” of vaginal delivery after c-section is uterine rupture. This is when the cut used to deliver the baby that became a scar breaks open during labor.
This is very rare (1% of all attempted VBACs kind of rare).
Due to the seriousness of uterine rupture, most women who have had previous cesarean section are either (in-hospital):
1. Automatically scheduled for a repeat c-section
2. Scheduled to induce labor that most often leads to c-section due to stalled labor and fetal distress (recall the side-affects of Pitocin).
Smart fact: Physicians don’t like to induce women who have had a previous cesarean because it increases the risk of rupture.
The type of incision also plays a factor in the risk of possible uterine rupture.
A low, side to side incision (transverse) is less likely to rupture. This type of incision is performed low on the stomach and is often called the “bikini cut” due to its placement and shape. It is considered safer than the classic cesarean section incision which resulted in more blood loss and was not as easy to repair (higher on the stomach).
Lastly, the risk of uterine rupture is increased by each additional cesarean section, putting a woman at higher risk for each pregnancy.
It is due to this life threatening risk that some doctors in the United States will not offer VBACs to mothers, but rather schedule for the next or induce labor which usually results in a repeat cesarean. Even if your doctor feels comfortable performing a VBAC, his or her insurance company may not allow it. Their “hands are tied.”
Make sure you discuss this in length with your care provider if you’ve had a previous cesarean.
The Home Birth Option
Midwives who perform home births may accept VBAC moms.
So if you’re dead-set on trying for a vaginal delivery after cesarean and can’t find doctor who will accept you, this could be your perfect option.
However, if you’re not comfortable birthing at home, you can have a VBAC in a hospital.
Even if you have to put up a fight. It might be a big fight. But you can win. For all those needing a little inspiration in this department, check out Gina’s (aka The Feminist Breeder) VBAC Story. Where there’s a will, there’s a way.