Another Strike Against C-Sections

A Team of Doctor Perform a C-section (the doctors are huddled around the woman's abdomen working to extract the baby, the mom's view is blocked by the blue barrier sheet)

A Team of Doctor Perform a C-section (the doctors are huddled around the woman’s abdomen working to extract the baby, the mom’s view is blocked by the blue barrier sheet)

I was at my friend A.’s birth two years ago. After laboring all day and well into the night, A. was getting exhausted. The fetal monitor showed that the baby’s heart beat was dropping during contractions and the labor nurses, who called the doctor (she was at home sleeping), were starting to act worried.

The doctor made the call: A. needed an “emergency” C-section.

The anesthesiologist, a handsome, kind man in his late 50s who all the happily married nurses had a crush on, allowed us to be in the operating room. So A.’s husband, her doula, and I were all present for an operation that was done competently and carefully, while A. was awake. Even though they put up a shield between the mother’s head and her belly so she couldn’t see that her abdomen was being cut open, they held up the baby for her to see soon after he was pulled out. The doctors gave him some oxygen, cleaned him up, wrapped him in a blanket and then nestled the baby next to his mom.

It was a beautiful operation and the baby was welcomed by many concerned loving hands.

But even when all goes well, there are many reasons to avoid having a C-section and it’s hard not to second guess this one.

What if the doctor–who had built a relationship of trust and love with her patient during the prenatal care–had come to the hospital and stayed with us for awhile? What if she had told my friend that everything was proceeding normally and that she was doing a good job and the baby would come in his own time before the monitor indicated there may have been a problem? What I mean is, what if the doctor had been present for more than just the radical intervention? And what if the nurses, instead of poking and prodding and monitoring, had given my friend some healthy food to eat, rubbed her back, and helped boost her confidence?

It was the middle of the night. We were all tired. But A.’s labor really was progressing well, the sensations were becoming more intense, and she was getting to that point that most women hit where she was feeling like she couldn’t get on top of the contractions. She was something like five centimeters dilated by then. With a little encouragement (and a lot less distracting and rather ridiculous monitoring), maybe my friend’s baby could have been born vaginally.

Just because cesareans are becoming more common does not mean they are a good thing.

“Cesarean is a life-saving surgery that has major risks and is being used routinely. That’s an oxymoron,” said Medford-based midwife and homebirth advocate Augustine Colebrook when I called her last week. “It’s being drastically overused and abused.”

This major abdominal surgery involves serious risks to the mom and the baby, putting the mother at risk for hemorrhage, infection, and organ damage. The incision is painful and takes time to heal, which means that most moms can’t lift their babies after having a C-section, many experience discomfort breastfeeding because when they try to hold their baby they have to make sure the position is not hurting a still weepy wound. Breastfeeding is also more difficult because the anesthesia used makes mother and baby sluggish and interferes with bonding. And women who have C-sections have a longer recovery time than after a vaginal birth.

My friend Katelyn, whose baby was born eleven years ago, still hasn’t fully recovered from the C-section birth. She had such uncomfortable bloating and gas after her son was born that she was miserable. She could barely get out of bed for days and she couldn’t drive for six weeks. Finding the transition to motherhood difficult, Katelyn was also scared to hold her son because she was sure she would drop the baby. To this day she has bowel difficulties that she feels certain are related to her son’s birth.

If C-sections are difficult for the mother, they’re also difficult for the baby. Studies have shown that babies born by C-section are at a higher risk for allergies, asthma, Type 1 Diabetes, fetal injury, and breathing problems, among other things. The squeezing action of a normal vaginal birth helps get liquid out of a neonate’s lungs. But babies born by C-section don’t get this benefit and are often at risk for respiratory distress. That’s what happened to my friend Nora’s baby. A scheduled C-section, the baby was much smaller than the doctors expected and one of his lungs collapsed. He had to be medically evacuated and he spent the first weeks of his life in the NICU in a hospital far from home. Babies born by C-section can also get bruised or cut from the operation, putting them at increased risk for hemorrhaging.

But there’s another reason to try to avoid a C-section if you possibly can: Last week researchers announced that babies born vaginally have very different bacteria on their bodies than babies born by C-section.

Though we think of bacteria as “bad,” we humans actually need to have lots of “beneficial bacteria” in our bodies. As a baby is born from the womb, he or she gets inoculated with his mother’s vaginal bacteria. This is a good thing and is thought to be protective.

But a baby born abdominally does not get the benefit of this inoculation. Instead of having her mother’s bacteria on her body, she has whatever bacteria she picks up in the hospital.

According to a Colorado University news article:

“Dominguez-Bello [one of the study co-authors] said the bacterial communities of C-section babies were dominated by species from the Staphylococcus genus, most of which are harmless but a few of which can cause severe infections. “These differences we are seeing in this study might be related with increased health risks in C-section babies, although more research is needed,” she said.

Previous studies indicate babies born via C-section can be more susceptible to certain pathogens, allergies and asthma than newborns born vaginally. The PNAS study results may help explain the higher incidence of Methicillin-resistant Staphylococcus aureus, or MRSA, in C-section babies, a hard-to-treat bacterial infection that has been increasing in hospitals and clinics in recent years, according to the researchers.” [my emphasis.]

The study itself is published in the June 21 issue of the Proceedings of the National Academy of Science (PNAS). You can read the abstract on-line here.

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14 thoughts on “Another Strike Against C-Sections”

  1. Scary. Yet one more reason to let nature take its course over yet more, possibly unnecessary, medical intervention.

  2. I know several other women who gave birth around the same time I did (last July), and several who have given birth since. All of the women who gave birth in the hospital ended up with “emergency” c-sections! Those who gave birth at home had vaginal births with no complications whatsoever.

    When I choose to give birth at home, one of the biggest reasons was to avoid a Cesarean. I saw a lot of first time women choose hospital births. When they went past their due dates, they were induced, and because their bodies weren’t ready for the labor that was artificially induced, and because the labor took too long by doctors and nurses’ standards, their babies were removed from their abdomens!

    My daughter’s birth was a painful, beautiful process and a right of passage that I am proud to share with eons of women before me. This post touches on many compelling reasons to avoid a c-section. For me, the biggest one was the fact that my body was meant to deliver a baby vaginally!

  3. What arrogance for medical professionals to assume that natural selection has not already ironed out virtually all possible problems in vaginal birth! If it didn’t work consistently and robustly without interference, the genes could not be passed on. If done naturally and patiently, it must work out except in rare cases–to deny this is to deny evolution. The whole history of death in childbirth is one of iatrogenic causes, and this has not entirely abated even today, when the large number of convenience caesarians means needless risk from an unnecessary surgery.

  4. I really struggled when a friend (close friend) elected to have a c-sec (planned) b/c she didn’t think she could handle or wanted to handle labor.

    That said I’ve been at c-secs that were just going to/had to happen, thank goodness.

    I actually thought the article I read on the bacteria had potential to twist something before we really know if it’s true. In my mind, I didn’t discount it, but can’t put weight on it either.

    Here’s another of those situations when just because the trend moving to c-secs is bad we have to be so very careful not to demonize them beyond the beyond. I mean, I wrote a long essay on pumping (& supplementing) many years ago & it was rejected from this very publication b/c Mothering doesn’t endorse formula. Formula saved my kid’s life (& he nursed for 2 years). Grey areas matter… a lot.
    .-= Sarah Buttenwieser´s last blog ..Shooting Straight in the Dark =-.

  5. I had two c-secs (first one emerg second one planned) but I wish I had been encouraged to labor longer with the first one. I’m not sure what to make of the study about bacteria either. It’s interesting for sure. I think it’s important to say that every mother has to make what seems to be the best choice for her and her child at the time.

  6. In the interest of full disclosure, I have to write that my DH is an ob/gyn. That doesn’t mean, however, that I’m willing to act as a rubber stamp for the medical profession and I don’t subscribe to the “doc as god” school of thought 🙂 Also, I advocate home birth fanatically believe that a woman should “own” her birth experience.

    That said, there are circumstances where a c section is the safest way to deliver the baby. For example, when the umbilical cord is prolapsed, when the baby’s head is of a size where it would be physically impossible for it to fit through the pelvis, placenta previa, etc.

    Three or four years ago, DH performed a c section on a woman who, it turned out, had placental abruption. If I remember correctly, the woman was doing a home birth and the midwife either didn’t recognize the condition or waited too long before instructing her charge to go to the hospital. By the time she got to the hospital, the baby was suffering from a lack of oxygen (detected once a monitor was hooked up. Monitoring the baby is not always a bad thing!) and in the few minutes it took to get the mom into the operating room and opened up, she lost her child.

    That was a devastating tragedy and my heart aches for that poor mother and I am not quite comfortable using her story as an example on an Internet message board. Also, I know that the overwhelming majority of births are uncomplicated But I really wanted to show that there IS a place for interventional medicine in the birth experience.

    I am, however, very much against a c section for the convenience of the mother or doctor, because she is “afraid” of labor pain or because she doesn’t want to “stretch out” her lady parts (yes, that happens!)

    Jason, I respectfully disagree with your assertion that the whole history of death in childbirth is due to iatrogenic causes. I’m trying to recall some minutae from my college thesis on motherhood in colonial times and I believe that the prevalent causes of death during childbirth were dehydration, infection and hemorrhage (in no particular order). Since I still find this topic fascinating, though, I would love to read your sources!

    Everyone, thank you for reading this diatribe!

  7. Tracy,

    Yes, of course, there is a role for emergency c-sections, and the sort you point out are indeed emergencies. My comment is about the convenience c-sections that are wrongly called emergencies (not to mention the planned convenience or cosmetic c-sections!). The iatrogenic deaths in childbirth: our idea of birth as an exceptional, traumatic, life-or-death crisis emerged during the transition from traditional homebirth with midwives to the “man-midwives,” as doctors attending birth were first called in England and the Colonies, in the 18th-19th centuries. (There were several types of doctors, physicians, surgeons and attending apothecaries then which don’t correspond well to modern categories, and needless to say none of them were practicing what we would call scientific medicine until near the end of that period.) Lister’s original insight in germ theory and the importance of hygiene came because he saw the shockingly high incidence of infection during and after birth attended mainly doctors, who had often been doing other medical tasks and autopsies before the birth without washing their hands. Basic hygiene in those situations brought dramatic improvement in results. But the fear lives on, and sadly our death rates to both mother and infant in the US are far higher than in most developed countries, even though we spend far more per birth and are supposed to be the experts. We aren’t getting the results. Our c-section rate shocks the world and has been internationally criticised (though it is not the highest). When OBs are performing numerous unnecessary surgeries (about a third of US births!), they introduce the dangers of any surgery, and the danger of mistakes, which doubtless contribute to the rate of bad outcomes.

    Thanks for speaking up on the other side of the issue–discussions are much more valuable with diversity of opinion, and more interesting to read, too.

  8. I had a c section (too much for me to comment about why at the moment), but I want to echo everything you are saying here. I hear so many women say things like “I want a C section. It’s easier.” But while, sure, you avoid the pain of childbirth — which lasts about 24-48 hours or so–you trade it for pain that lasts days, weeks and months. You trade it for not being able to drive a car for four weeks, which means you are a shut in with a newborn. Which means your risk of PPD goes up dramatically. It means you are not supposed to carry anything heavier than your baby. That means if you have older children, they are going to feel even more neglected and shoved aside by the newborn. It means a lot. It’s not something people should do because they are afraid of pain or because they don’t want to face a vaginal birth.
    .-= Alisa Bowman´s last blog ..The Project- Happily Ever After

  9. My daughter-in-law had a C-section last week. I had no idea of all the extra problems that would be involved. Thanks for enlightening me. I will have to make a point to call the baby’s older sister more regularly on the phone.
    .-= Alexandra´s last blog ..Leslie

  10. Good post, Jennifer. This is a sore point for me, especially living in a country now where the c-section rate is much lower (and natural, undrugged birth rate is vastly higher – in fact, it’s quite difficult to find a caregiver in Japan who will give an elective epidural – which as we know starts a cascade of interventions). I think my older two children could possibly have been c-section births had we had them in hospitals because pushing took so long. I actually had a placental abruption while pregnant with the first, and had to switch hospitals several times until I found one which had a doctor who was willing to wait and watch instead of beginning interventions (at 33 weeks!) which would have increased the chance of needing a c-section.

    It’s hard, but important, for people to have the right information so they can advocate for themselves in this medical system.
    .-= Christine´s last blog ..Guest Post at Words To Eat By – Asian Noodle Salad =-.

  11. I really hate this topic. I always feel like I have to defend myself and my doctor.

    I’ve had 3 sections. Each for their own reasons (and certainly NEVER for convenience). Each were incredibly difficult to endure and recoup from (never mind the complex I wound up with by not being able to deliver “normally.”) But I’m grateful for them since I have my three wonderful and perfect children.
    .-= Claudine´s last blog ..Little Ballerinas -amp Dress Rehearsals =-.

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