Cesarean births are at a high in the states. Many find themselves not knowing all the facts around the pros and cons, information on gentle cesareans and finding themselves at a standstill with providers that support VBACS, vaginal birth after cesarean section with their next pregnancy. This will be a 3 part blog post to better understand your options around cesarean births.
It is believed that 1/3 women delivered by a cesarean birth as of 2011, according to ACOG, The American Congress of Obstetricians and Gynecologists. Cesarean deliveries have been on the rise in the United States for some time now and question is are they really needed as often as they are performed. As a birth and postpartum doula, I have witnessed the times when a cesarean birth is needed to save the lives of mother, baby and at times both. I am humbled every time I work with a family whose hand I have held through the surgery, have met after in the recovery room or have supported after the birth to help smooth their transition.
Cesarean rates vary according to hospitals and care providers. Many find as they near their due date, reasons for inductions and cesareans may be mentioned. Some common reasons that this conversation is brought up in the final stretch of pregnancy may be that a baby is measuring “too big”, one is past 41 weeks, low amniotic fluids as one nears their due date and preeclampsia with protein present in ones urine. Some reasons a cesarean may be known as the best way to birth from earlier on in pregnancy are at times breeched presentation, placenta abruption; the separation of the placenta from the uterine wall and a pregnancy with multiples, amongst others. Once again, this is all dependent on care provider, their skill set and comfort level with delivering vaginally with such circumstances. Placenta abruption and an active STD outbreak allows no room for a vaginal delivery. There are also key questions to consider with each situation such as has body work been done, such as chiropractic or acupuncture, what position is baby in and is a trial of labor okay?
Once in labor these reasons differ a bit. It is common once in labor and at the hospital, the birthing person finds themselves being monitored continuously and in bed without movement and activity. This may lead to labor arrest or the slowing down of labor, the concept of dilation, the opening of the cervix not happening at 1 cm per hour, as preferred when once in the hospital, or dilation stopping at 4 cm with no cervical change for more than 2 hours. It is known that the use of continuous monitoring restricts the ability for gravity to work with labor by getting baby down and out. Also when looking for something, more than likely you will find it. It is believed that continuous monitoring only gives room to detect any and everything that can happen, leaving medical staff on high alert. Non reassuring fetal tracing is the second most common reason for cesareans. Decelerations, or drops in babies heart rate from the normal baseline, without a quick enough recovery time is a common defense for a cesarean to be performed with the readings from the Fetal Electronic Monitor often used as avisual evidence . The use of the readings from the FEM becomes debatable because each care provider interprets the readings differently as well as changes in the laboring persons position and access to oxygen often help improve the patterns in these readings as well as the wellness of baby.
Malpositioning of baby, usually a breeched/transverse positioning of baby is the next common reason for cesarean births, followed by multiples, maternal request and pre-eclampsia (high blood pressure with protein in urine) respectively. Delivering a breeched baby is now a lost art amongst care providers. Some may have luck researching hospitals in surrounding states that have doctors that still deliver breeched babies vaginally. However presentation of foot first vs butt first will determine the method of delivery the care provider is comfortable with as well as might be best for both the birthing person and baby.
Some things to keep in mind when aiming for a vaginal delivery whether with or without an epidural;
Stay Hydrated: Lack of fluids can lead to pre-term contractions, low amniotic fluids, as well as dehydration. One tends to lose a lot of fluids when in labor between peeing and at times vomiting and diarrhea. Water, Coconut water, Iced Herbal Teas such as Nettles are all great options for hydration. If ever questioning fluid levels, up your fluid intake and retest. Also an infusion is an option or internally putting fluids back inside.
Move: Gravity works with your body and baby to get baby down and out. Movement helps keep your hips engaged and open. A great tool for pregnancy and labor is a birthing (yoga/stability) ball. This helps with a supported squat, rotation of hips and alleviating back labor.
Inquire: Always question the pros and cons of a routine procedure and whether it is medically indicated or an evidence based practice. If something is done out or policies and procedures they may do more harm than good, as well as not be necessary. One always has a choice.
And remember, this is your birth story. The key to making decisions is for them to be informed and equipped with knowledge. As a doula, although never aiming for a cesarean birth, I introduce conversation about a compassionate cesarean or gentle cesarean, also known as a family centered cesarean at some point in a prenatal. Families should always know their options and what their care providers are supportive of beforehand. For many finding themselves needing or finding a cesarean best for their birth, a compassionate cesarean may be an option. For more information on compassionate cesareans one may check out the learning lab at http://learn.doulatrainingsinternational.com/courses/compassionate-cesarean, and other online modules with advanced trainings for doulas, care providers and parents on various topics.