Birth Experience

Birth Management & Interventions – Cesarean Section

10 Comments 05 March 2010

“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?

Physical risks to mom include infection, risk of blood clots and excessive bleeding.

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.

VBAC risks:

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.

Your Comments

10 Comments so far

  1. Fiona says:

    out of my friends who have had caesarians the following were without a doubt essential:
    - monochromatic twins (one sack, cords tangled)
    - 31wks and serious maternal illness (required liver transplant 3 days after birth)
    - 27wk pre-term birth
    - transverse lie and breech (the second is more controversial but becomes more risky to have VB with breech as doctors become deskilled)

    Then there are all the ones who had the ‘cascade of interventions’ leading to ‘failure to progress.’

    My doctor partner tells though of all the babies who were ‘in distress’ as shown by CTG, and born by CS only to come out pink, healthy no problems.

  2. Fiona says:

    sorry i meant mono AMNIOTIC twins LOL

  3. Dr Sumithra says:

    Cant blame Doctors also Becuase their life is at risk becuase something happens to the baby the DOctoe is sued In India this story very complictaed in India where they sue the Doctor everything

  4. Rachel says:

    Just to add some more indications that requires a c-section…

    placenta previa and prolapsed cord

    The ones you mention I think depend on the situation and mom….and are a little bit more hazy.

  5. Heather M says:

    While I agree on some of what was written, every situation is different. I can only talk from my own experience I was in labor for 20 hours pushed for 3 1/2 hours and after a failed suction my son wasn’t budging and they preformed an emergency c-section. At my 6 week check they told my pelvic area is very very narrow especially for my body (5’6 135lbs) and my son was large, I don’t feel ashamed for having to had a c-section. As far as emotional yes it was hard to be in recovery away from him for a bit but once I held and talked to him my son knew exactly who I was and I felt even more attached to him then when he was in the womb, breast feeding is a process no matter how you had your baby it takes some time to get into a good groove and We both did great and he was never given a bottle before I got to him so there was no nipple confusion. I think if you have the option for a vbac it’s great but there’s no need to have people feel they are any less of a woman for having to have a repeat c-section. My experience was rare but I feel very strongly that I deserve just as much recognition as someone who had a vaginal birth.

  6. Auzie says:

    Heather that is so true! I would have loved nothing more than to have a vaginal birth but unfortunately never even went into labour first time round. My son had a bad trace on ctg. I woke up with an instinctive feeling something was not right and he was not moving as per usual that morning so went to get checked out. Just before his emergency c section they could not find his heart beat on a doppler. If I had of attempted a vaginal birth with him that day I don’t know that we would have got far! I was told by my midwife if he was inside me another minute he might not be with me today. So I never felt one bit of guilt about that c section! This was needed to save my babies life! That’s what is mostly important. When I had my second pregnancy I was so very keen for a vbac but at 37 weeks was told I had too much fluid and a my daughter was transverse/ unstable lie. So it was really not a hard decision for me after I was told the dangers of this! I booked in for a c section the next week. After going through the pain of my first baby so sick after birth there was no way I was going to risk any complications again! Especially not just because I wanted a vaginal birth. I do sometimes wish I could have had the whole natural birth experience but I have still given birth if my children were pushed or pulled in my opinion.


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