Should you choose a cesarean?
Recent figures show that 30.2% of US births are cesarean deliveries and it’s a hot topic for debate among moms, doctors, midwives and governments. While there’s no doubt that in many cases cesareans save the lives of thousands of women and babies the surgery isn’t risk-free for either mom or baby, so the potential risks should be outweighed by the potential benefits.
Why you might need to plan one
If there are medical reasons that make a normal delivery risky for you or your baby and you’ve explored all your alternatives, then a planned c-section may be the safest option. “Some situations are more black and white than others,” says Tonya Jamois, President of the International Cesarean Awareness Network (ICAN), who advises women to discuss it with their care providers and then do follow-up research themselves. “In reality, every birth can become complicated,” she explains. “Doctors may point to something that could happen – for example, you may be advised to have a c-section because sonographs indicate your baby is too big to birth vaginally. But sonos have a large margin of error and your baby might not be too big at all – if you know this, you can make a more informed choice instead of being needlessly frightened into ‘choosing’ a cesarean you may not need.”
Generally accepted reasons for a cesarean include:
- Placenta previa at full term This is where the placenta implants too close to, or covering, your baby’s exit from the uterus. Under these circumstances, a natural delivery will not be possible.
- Transverse lie at the time you go into labor – this is where your baby is lying crossways in the uterus.
- Prolapsed cord This occurs when the umbilical cord drops down into the vagina ahead of your baby, potentially cutting off his supply of oxygen.
- Abrupted placenta If your placenta starts to detach from the uterus before you’ve gone into labor your baby needs to be born straightaway.
- Eclampsia or severe pre-eclampsia Your labor will be induced but if the induction fails you will need a cesarean delivery.
- Severe fetal distress This will be confirmed with fetal scalp sampling or a biophysical profile. A failed induction can result in fetal distress.
- True cephalo-pelvic disproportion If your baby is too big to pass through the pelvis.
- Active herpes at time of labor.
- Health issues If you have a medical condition that means labor would be potentially dangerous to your health (for example, heart disease or HIV) a cesarean may be less stressful. The same applies to your baby if he has an illness or congenital condition that makes a cesarean safer.
A cesarean can be a lifesaver when it’s absolutely necessary – but overusing it without good medical reasons puts moms and babies at risk
When it might not be needed
In many cases, the reason for a cesarean can be more controversial. “You may be advised to consider one if you’re an older mom-to-be, your baby is breech (bottom or feet first) or you’ve been pushing for a long time,” says Tonya Jamois. “Fetal distress is often offered as a reason, but this is very subjective, as is a diagnosis of ‘failure to progress’, which may well be more a case of ‘failure to wait and be patient’.” She points out that although a c-section is more likely in certain situations, you may well be able to deliver vaginally with the help of a supportive care provider.
Vaginal birth may be possible for:
- Breech baby Most babies turn into a head-down position prior to birth but some stay bottom or feet-first. While it is possible to deliver a breech baby naturally, many OB-GYNs advise against it. Because so few women do it, many health professionals won’t have any experience of attending a breech birth and this could compromise your care if complications occur. “It’s important to choose an experienced care provider if you choose to go ahead with a vaginal breech birth,” says Tonya Jamois. “Often midwives can be more experienced in this area.”
- Large baby Most babies ‘fit’ their moms and, all being well, will pass through your pelvis without complications. However, if your OB-GYN feels your baby’s head is too large, a cesarean will be recommended. “Sometimes the problem with fit isn’t size at all but rather the position of the baby,” Tonya adds. “Your head-down baby may be in what’s called a posterior position, with his spine against yours instead of facing to the front. This means he emerges ‘sunny side up’ – face up – and this can make labor longer and more painful. Moms who want to get their babies into the best position need to research optimal fetal positioning – your OB-GYN or midwife can help on this.”
- Multiple birth Many OB-GYNs feel a cesarean is a safer for moms of multiples. Tonya Jamois recommends you choose a care provider who has experience delivering multiples to increase your chance of a vaginal birth.
- Placenta previa Get a late sonogram before you commit to a cesarean for this reason, Tonya says. “A placenta that was low-lying at 20 weeks may have moved further up the uterus and well away from the cervix by 36 or 37 weeks. It’s always better to check again.”
- Previous cesarean Assuming your baby is in a good position and you are both healthy, it’s possible to deliver him naturally even if you’ve previously had a cesarean and many women do achieve this. However, it may not be up to you – ICAN’s research suggests that over 300 US hospitals and thousands of physicians have banned vaginal birth after cesarean due to fears over malpractice lawsuits if something goes wrong.
Too posh to push?
More women are choosing to have cesarean deliveries for no apparent medical reason. Women may be attracted by the notion that they can schedule the birth at their own convenience, be awake to cuddle their newborn without a long, stressful labor and avoid the ‘wear and tear’ of a vaginal delivery. Many obstetricians also favor it as a method of delivery because it’s safer from a legal point of view.
However it’s vital to bear in mind that while cesareans are safer than ever due to advances in surgical techniques and medical care, they don’t come without their own downside – not least of which is the fact that they aren’t safer at all. There are risks of complications and the recovery period can impede bonding and establishing breastfeeding. A cesarean baby is at risk of respiratory problems and at long-term risk of asthma and allergies. For mom, the risks are equally serious – hemorrhage, infection, blood clots, serious short-term and long-term pain, injury to other organs and complications in future pregnancies, including infertility, ectopic pregnancies, miscarriage, stillbirth and potentially dangerous placental abnormalities.
Think about your circumstances too, says Tonya Jamois. “For example, you’re not allowed to lift anything heavier than the baby you just had after a cesarean and this could be a big factor in your decision if you have a toddler at home. Saying ‘Mommy can’t hold you right now’ can be difficult for toddlers and older kids to understand, especially when they’re trying to adjust to a new baby in the house and may be feeling left out.” If you find yourself in this situation after a c-section, finding extra time to read a book together or have careful cuddle time can ease the transition.
But natural has its downsides too
Just to complicate matters, natural childbirth comes with its own risks. Labor can be a long, exhausting process that leaves you too tired to push out your baby. While an epidural can make it easier to endure, not being able to feel when you’re pushing can prolong that stage of the delivery – increasing the risk of your baby needing to be delivered with forceps or vacuum. Natural birth can also result in tearing of the perineum and long-term discomfort. “Finding a supportive care provider can make all the difference,” Tonya Jamois says. “Look for one who will allow you to eat and drink as you wish, since this will reduce the risk of exhaustion. A provider who has a low rate of vacuum and forceps use, offers good perineal support during pushing, and encourages moms to stay off their backs will reduce the risk of tearing. In addition, a provider who can support pain coping techniques such as soaking in a tub or birthing pool during contractions and massage techniques, will help you if you choose not to have an epidural or if the epidural doesn’t work for you.”
It’s your choice…
That’s what it comes down to in the end and many experts argue that just as women can choose to go the natural route, they should also be able to choose a cesarean. The best advice is to find out as much as you can about it. Listen to your OB-GYN’s advice – but search out info on natural birth, labor positions, pain relief options, different birth options, midwife births or doula support. It could make all the difference between feeling confident in your body’s ability to give birth and feeling put off by fears of the unknown.