Joy in Birthing

“Technology accelerates our progress, but that is often only a progress towards acceleration”-Aldous Huxley.

Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the rate of babies born by cesarean section (C-section) in the U.S. is on the rise with approximately 1 in 3 babies in the United States being delivered by cesarean section, many elective.

Even though,  the practice of elective cesareans is controversial among health care providers,  in 2003  the American College of Obstetricians and Gynecologists (ACOG) issued a statement essentially approving elective c-sections. Using patient autonomy as their justification, the ACOG took the position that doctors may ethically perform an elective cesarean that’s medically unnecessary as long as they feel it’s “in the best interest of the patient.” Some  question how many elective c-sections patients truly choose and how many are “convenience surgeries” pushed by medical professionals who don’t want their vacations or weekends interrupted by a spontaneous delivery. I can’t begin to tell you how often the phrase “I am concerned that your baby might be too big to deliver vaginally,” is heard by moms as early as on their 36th week gestational visit.

The Coalition for Improving Maternity Services (CIMS) also says that mothers who deliver by cesarean are less likely to breastfeed and may have more difficulty with infant bonding. Michel Odent, MD,  says ( and I paraphrase,) women will have problems bonding after a cesarean because it prevents the release of oxytocin, the “love hormone.”

Birth can be a slow and unpredictable process, which requires little or no technology. Yet, surrounded by all the gadgets and the gismos of modern technology, the industry of birth tends to want to use them. Many reasons given for a cesarean, especially prior to labor, can and should be questioned. A cesarean section is major abdominal surgery; the infant is delivered through an incision in the mother’s abdomen and uterus. The cesarean rate is alarmingly high in many industrialized countries, causing unnecessary risks to both mother and baby.

C-section can be a lifesaving operation when either you or your baby face certain problems before or during labor and delivery. Most cesarean sections go well for both the mother and the baby.  A cesarean section is major surgery and should be done only when the health of the mother or baby is at risk.

Many experts think that up to 50% all c-sections are unnecessary and the U.S. government is trying to reduce the rate.

There are very few true indications for a cesarean section in which the risks of surgery will outweigh the risks of vaginal birth. Some cesareans occur in critical situations, some are used to prevent critical situations. Here is a list of the most common reason a cesarean might be necessary or might be discussed but not necessary This list was compiled from many wonderful websites dedicated to the prevention of unnecessary cesareans including:  www.ican-online.org and  the extra risks are taken verbatim  from www.childbirthconnection.org

Placenta previa

This occurs when the placenta lies low in the uterus and partially or completely covers the cervix. 1 in every 200 pregnant women will experience placenta previa during their third trimester. If a marginal placenta previa has been diagnosed, a vaginal delivery may be an option.

Placental abruption

This is the separation of the placenta from the uterine lining that usually occurs in the third trimester. Approximately 1% of all pregnant women will experience placental abruption. The mother will experience bleeding from the site of the separation and pain in the uterus. This separation can interfere with oxygen getting to the baby and depending on the severity; an emergency cesarean may be performed.

Cord prolapse

This situation does not occur often but when it does an emergency cesarean is done. A cord prolapse is when the umbilical cord slips through the cervix and protrudes from the vagina before the baby is born. When the uterus contracts it causes pressure on the umbilical cord which diminishes the blood flow to the baby.

Fetal distress

The most common cause of fetal distress is lack of oxygen to the baby. If fetal monitoring detects a problem with the amount of oxygen that your baby is receiving, by showing a constant deceleration in the baby’s heart beat then an emergency cesarean may be performed.

Failure to progress in labor

This can occur when the cervix has not dilated completely, labor has slowed down or stopped, or the baby is not coming down the birth canal during the pushing phase. This can be diagnosed correctly once the women is in the second phase (beyond 5 centimeters dilation), since the first phase of labor (0-4 centimeters dilation) is almost always slow. Beware; sometimes mom’s internal clock is very different then the hospital or care-provider’s clock. As long as the baby is healthy and mom is doing well it is up to you how long you are willing to wait for your body to dilate. Failure to progress often happens during an induction, especially if the woman is induced too soon, or if mom or baby doesn’t respond well to the induction medicine.

Repeat cesarean

You may be surprised to find out that 90% of women who have had a cesarean are candidates for a vaginal birth after cesarean for their next birth (VBAC). The biggest risk involved in a VBAC is uterine rupture, which happens in 0.2-1.5% of VBACs. However, there many doctors don’t like doing VBACs or are requested to be with you the entire hospital stay. Visit ICAN- Online.org or, VBAC.com to get more information on VBACs.

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Active genital herpes

If the mother has an active outbreak of genital herpes (diagnosed by a positive culture or actual lesions), a cesarean may be scheduled to prevent the baby from being exposed to the virus while passing through the birth canal.

Diabetes

If you develop gestational diabetes during your pregnancy or are diabetic, you may have a large baby or other complications. Your care provider may suggest having a cesarean. Granted that it is better to have the baby not much past the 38 week of gestation, due to his possible size, there are many diabetic women who will have a successful vaginal birth. Discuss natural methods of induction with your care-practitioner, and be open to a medical induction.

Preeclampsia

Preeclampsia is a condition of high blood pressure during pregnancy. This condition could prevent the placenta from getting the proper amount of blood needed and decrease oxygen flow to the baby. Delivery is sometimes recommended as a treatment for this condition. Only with severe preeclampsia is a cesarean needed.

Birth defects

If a baby has been diagnosed with a birth defect, a cesarean may be done to help reduce any further complications during delivery. Nevertheless, a vaginal birth of a disable baby might make you feel a lot stronger and better about working together to overcome life challenges, so make sure the doctor is not suggesting this solution because he/she thinks that you should not go through the pain of labor coupled with the troubles of having a disabled child. Ask a lot of questions and choose this avenue if this is the only safe way to delivery your particular baby.

Breech position

When dealing with a breech baby, a cesarean delivery is often the only option, although a vaginal delivery can be done under certain circumstances. Unfortunately most doctor are no longer taught how to delivery a breech baby, thus in the United States almost all breech babies are delivered via cesarean. If you feel strongly about wanting a vaginal birth, and you feel confident that you can do it, research for a doctor or a midwife in your area that will give you the option of delivering a breech baby. However, if the baby is in distress or has cord prolapse (which is more common in breech babies) a cesarean is necessary.

Multiple births

Twins may be delivered vaginally depending on their positions, estimated weights and gestational age. Multiples of three or more are less likely to be delivered vaginally, but is not impossible. Again most doctors feel more comfortable delivering twins or triplets via cesarean. If the babies are in a head down position there is really no need to perform a cesarean. Discuss your wish for a natural childbirth in details, and find a doctor who will deliver a breech baby as sometimes one twin is head first and one is breeched.

If you consider a cesarean, it is important to weigh any benefits the surgery is expected to offer against the risks involved. The benefits depend on your specific situation and the reason why your doctor or midwife may be recommending a cesarean. It is important to discuss these issues with your caregiver.

Here are some extra risks associated with cesarean section: Current research suggests that cesarean section has the following disadvantages  (19) in comparison with vaginal birth (3):

• Physical problems in mothers: Compared with vaginal birth, cesarean section increases a woman’s risk for a number of physical problems. These range from less common but potentially life-threatening problems, including hemorrhage (severe bleeding), blood clots, and bowel obstruction, to much more common concerns such as longer-lasting and more severe pain and infection. Even after recovery from surgery, scarring and adhesion tissue increase risk for ongoing pelvic pain and for twisted bowel.
• Hospitalization of mothers: If a woman has a cesarean, she is more likely to stay in the hospital longer and is at greater risk of being re-hospitalized.
• Emotional well-being of mothers: A woman who has a cesarean section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a vaginal birth.
• Early contact with, feelings toward babies: A woman who has a cesarean usually has less early contact with her baby and is more likely to have initial negative feelings about her baby.
• Breastfeeding: Recovery from surgery poses challenges for getting breastfeeding under way, and a baby who was born by cesarean is less likely to be breastfed and get the benefits of breastfeeding.
• Health of babies: Babies born by cesarean are more likely to:
  • be cut during the surgery (usually minor)
  • have breathing difficulties around the time of birth
  • experience asthma in childhood and in adulthood.
• Future reproductive problems for mothers: A cesarean section in this pregnancy puts a woman at risk for future reproductive problems in comparison with a woman who has a vaginal birth. These problems may involve serious complications and medical emergencies. The likelihood of experiencing some of these conditions goes up sharply as the number of previous cesareans increases. These problems include:
  • ectopic pregnancy: pregnancies that develop outside her uterus or within the scar
  • reduced fertility, due to either less ability to become pregnant again or less desire to do so
  • placenta previa: the placenta attaches near or over the opening to her cervix
  • placenta accreta: the placenta grows through the lining of the uterus and into or through the muscle of the uterus
  • placental abruption: the placenta detaches from the uterus before the baby is born
  • rupture of the uterus: the uterine scar gives way during pregnancy or labor.
• Concerns about babies in future pregnancies: A cesarean section in this pregnancy can affect the babies of future pregnancies. Studies have found that they are more likely to:
  • be born too early (preterm)
  • weigh less than they should (low birthweight)
  • have a physical abnormality or injury to their brain or spinal cord
  • die before or shortly after the birth
• Planned cesarean compared with unplanned cesarean: A planned cesarean offers some advantages over an unplanned cesarean (a cesarean that occurs after labor is under way). For example, there may be fewer surgical injuries and fewer infections. The emotional impact of a cesarean that is planned in advance appears to be similar to or somewhat worse than a vaginal birth. By contrast, unplanned cesareans can take a greater emotional toll.
• Planned cesarean compared with vaginal birth: A planned cesarean still involves the risks associated with major surgery. And both planned and unplanned cesareans result in a uterine scar and internal scarring and adhesions. This means women with planned and unplanned cesareans face similar risks in future pregnancies and for problems related to scarring and adhesions at any time

Extra risks associated with vaginal birth: In a few areas, mothers or babies with vaginal birth have poorer outcomes in comparison with cesarean birth.

• Perineal pain: While a woman with a cesarean birth is more likely to experience more intense and longer-lasting pain overall, a woman with a vaginal birth is more likely to experience pain in the vaginal area in the weeks and months after birth.
• Incontinence: A woman with a vaginal birth is more likely to leak urine (urinary incontinence) and to leak gas or, more rarely, feces (bowel incontinence). Pregnancy itself and other factors such as the woman’s weight play a role in these problems. Few women experience troubling symptoms beyond the recovery period in the weeks and months after birth.
• Nerve injury in babies: In comparison with a baby born by cesarean section, a baby who is born vaginally is more likely to have a nerve injury that affects the shoulder, arm or hand.

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Internal scarring is often not discussed when it comes to cesarean, here is what I have learned about scarring after a cesarean:

As a result of the natural healing process after surgery, internal scars called adhesions may form on or between internal organs and/or body tissue. The occurrence of C-section adhesions can be more of a health issue than visible Cesarean scars on the outside of your body because adhesions can be painful and debilitating. These internal scars may also cause complications with future C-sections and other surgeries.

Because C-section surgery involves the cutting and manipulation of internal tissues and organs, they may become inflamed. As a result of these tissues healing close together, C-section adhesions may form between your uterus, ovaries, bladder, and abdominal wall.

Some C-section adhesions do not cause problems. But adhesions that prevent tissues and organs from moving freely become a health issue, causing the affected tissues and organs to become twisted or pulled from their normal positions. (1. Lyell DJ, Caughey AB, Hu E, Daniels K. Peritoneal closure at primary Cesarean delivery and adhesions. Studies suggest that adhesions develop in approximately 50% to 70% of patients after their first C-section (Obstet Gynecol. 2005;106:275-80.)

Talk to your doctor about internal scarring. Good article about scar massage click here