In honor of Cesarean Awareness Month, I wanted to share information about cesareans from a variety of perspectives.
Amanda Devereux is an RN, a experienced doula, and a truly empathetic person with a heart for birthing women and women’s issues.
Her perspective is informed, unique, and deeply important.
Thanks for sharing, Amanda.
So here you are, nearly 10 months pregnant (yah, you get credit for all 10!) and preparing for your birth. Maybe you are or were planning a natural birth or maybe you would like to opt for an epidural; but sometimes a cesarean birth may be what’s right for you.
With cesarean rates in our nation hovering around 30%, and the WHO’s recommendation that cesarean rates be between 10-15%, there are certainly a lot of unnecessary cesarean births happening. There are risks that come with any surgery, and cesarean sections are no exception to that. When a cesarean birth is unnecessary the risk is great and you can read more about that here. Of course, when a cesarean birth is right for you, the pros outweigh the risks.
Here are five times a cesarean birth may just be the right birth for you.
True Fetal Distress
When your baby is not tolerating birth and your wee one’s heart rate is dropping during or after contractions and not returning to it’s previous baseline or is returning increasingly slow, or when your baby is not experiencing enough variability in it’s heart rate, these, along with the rest of your clinical picture, could be indicators that something is wrong.
Now, this doesn’t automatically mean that a cesarean birth is necessary, but it may be. Recent studies have indicated that continuous fetal monitoring results in higher cesarean rates, but not better outcomes.
Discuss with your care provider how they define fetal distress and what steps are used to remedy the situation before a cesarean.Your trusted healthcare provider will work with you to make this call. One of the many potential reasons for our country’s high cesarean rates may be the over diagnosis of fetal distress. However, if your baby is truly experiencing distress, a cesarean birth may be the best birth for you and your baby.
If you have experienced trauma in your past, a cesarean birth may your best birth. If you are a victim of sexual violence, from childhood or through adulthood, it is important that you decide what birth is best for you and for some women there is power, dignity and control in a cesarean birth.
Trauma can also come from a previous birth experience.
“Birth trauma is in the eye of the beholder.” – Cheryl Beck
You may have had a birth that to anyone else appeared like the ‘perfect birth,’ but for you it was traumatic.
Birth, all on its own, without condition for experience or outcome, is diagnostic criteria for PTSD. Women may have felt bullied, abused, violated, may have experienced birth rape or suffered a negative outcome or infant loss and their trauma is real and may impact future birthing decisions.
For women who have suffered trauma, pregnancy and birth can be a trigger and could subject them to further trauma. For some a natural vaginal birth or a vaginal birth with an epidural may be best. But, there are those for whom a cesarean birth is best. How do you know if this is best for you?
Have a dialogue with a therapist specializing in women and with your healthcare provider. Have your best birth.
Your baby’s position may impact how you choose to birth your baby. If your baby is transverse (lying across your belly) a vaginal birth is not possible. If your baby is breech, a vaginal birth may be an option for you given the skills of your health care provider, policies of your place of birth, type of breech position and your own risk/benefit analysis.
You may decide that your doctor does not have the skill set for a breech vaginal birth, that your baby is in an unfavorable breech position or that you do not wish to have a breech vaginal birth, and a cesarean breech birth might be right for you and your baby.
Placenta previa is a condition in which the placenta is partially or completely covering the cervix (the bottom turtle-neck like part of the uterus). In a vaginal birth the baby exits the uterus through the cervix, but when a placenta is in the way this causes a problem.
First, it’s blocking the exit. Second, if that placenta were to decide to move out of the way by detaching itself from the uterine wall, the baby would lose its oxygen supply and the mother could experience some terrible bleeding (hemorrhaging).
This is a pretty good reason to welcome your baby with a cesarean birth.
You Want One
You are a grown woman who can decide what is best for you. I believe we, as women, have the right to decide how we birth our babies. Women are capable of risk/benefit analysis and choosing what is their best birth. There are risks to cesarean births. Many are listed here and the risks increase with further pregnancies to include placenta accreta, adhesions, further birth complications and maybe the future struggle to vbac. And we certainly don’t fully understand what the impact of cesarean births may be for babies and mothers.
But, you are an intelligent being who is in full ownership of her body and can decide what type of birth is best for you, and you are within your right to choose a cesarean birth.
This is certainly not an exhaustive list, here are some more reasons ICAN says a cesarean birth may be best for you.
- Prolapsed cord (where the cord comes down before the baby)
- Placental abruption (where the placenta separates before the birth)
- True cephalopelvic disproportion (CPD), meaning that the head is too large to fit through the pelvis. This is often over diagnosed, it can be caused by maternal positioning either from restraint to bed, lack of mobility or anesthetics.
- Maternal medical conditions (active herpes lesion, severe hypertension, diabetes, etc)
Doulas offer you relational support, help facilitate conversation between you and your healthcare provider and will be there to support you through your birth and postpartum. Birth Boot Camp DOULAS are trained in supporting women through cesarean births!
And finally, when is a cesarean not best? When it is not what is best for you and your baby, when you are not offered informed consent or when you do not consent.
Want to know more about your hospital’s cesarean rates? You can look them up here!
Amanda Devereux is founder of Nola Nesting and the New Orleans Moms Club, a birth and postpartum doula, childbirth educator, (and almost IBCLC) in New Orleans Louisiana. She is also co-creator and trainer of Birth Boot Camp DOULA and holds a BS in Biology and Nursing. She’s a mom of three, smells like roses, and is a chocolate cake lover.