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Healthy Pregnancy Series: Caesarean Sections

admin May 4, 2011

While most babies these days are still delivered vaginally, a significant number — around 30% — are delivered via Caesarean section, or c-section.  This is a surgical delivery where babies are removed through an incision in the mother’s abdomen.  The c-section rate has been on the rise for a long time and is now often performed as a “scheduled c-section,” meaning planned and not an emergency, both for mothers who have had previous sections and mothers who simply prefer to have one.  But they’re major surgery and shouldn’t be taken lightly.

Why C-Sections?

Make no mistake: when used judiciously, c-sections can save lives.  The World Health Organization aims for a c-section rate at or below 10%; some studies suggest around 4% is ideal.  There are mothers who simply need a c-section.  This may include mothers who have misshapen pelvises, whose babies are transverse, who are having multiples, or who have other specific risk factors that make c-sections the safer way to deliver their babies.

Planned c-sections, scheduled for whatever reason (misshapen pelvis, for example), are usually done with a “low transverse” incision, or a small cut just above a woman’s pubic bone.  The baby is removed, as is the placenta, and the woman is sewed up.  There is a low rate of uterine rupture and other problems with this type of incision, as the uterus is thinnest here.  For the most part, these women will have an epidural, so that they can remain awake during the surgery.  Women who have this type of c-section can usually try for a VBAC (vaginal birth after caesarean) if they are good candidates otherwise.

Emergency c-sections may be performed with a low-transverse incision if possible; however, some women need to be cut from their belly buttons down to their pubic bones.  This allows the doctors the fastest way to get the baby out.  Very heavy women are more likely to need this type of incision.  Doctors can deliver a baby in less than a minute via c-section if something is wrong.  Some of these women may have general anesthesia if there is not enough time to administer an epidural.  It is incredible to have the sort of technology that can save a mother and/or baby’s life when necessary.

What’s the Problem?

We are way over that “optimal” 10% rate.  The country’s average is around 30%, and various hospitals can vary from 10 – 80% c-sections in first-time moms!  A lot of c-sections are performed for “failure to progress” (after mothers are induced too early, then strapped down to a bed, and not given much time to progress) or for the convenience of the doctor.  Women are not often adequately informed of the risks of a c-section as an elective procedure, either.

Clearly, c-sections are overused.  The following increases a woman’s chance of having a (probably unnecessary) c-section:

  • Being induced prior to 41 weeks (especially prior to 39)
  • Being given a “timeline” for progress
  • Having Pitocin, an epidural, and other interventions (“cascade” of interventions)
  • Laboring/pushing flat on her back

When interviewing doctors initially, it is important to ask what that doctor’s c-section rate is, and what his/her attitude towards c-sections is.  A doctor who has a high c-section rate and a cavalier attitude towards them is probably not the type of doctor you want to see.

Risks of a C-Section

What are the risks of having a c-section?  Let’s take a look at a few:

  • Negative/allergic reaction to anesthesia
  • Uterine rupture in future births
  • Excessive bleeding
  • Infection at the incision site
  • Cutting the baby (possibly badly)
  • Long/difficult recovery
  • Blood clots in the legs or lungs
  • Maternal death (rare)
  • Increased risk of NICU stay for baby
  • Breathing problems for baby (due to prematurity and/or fluid remaining in lungs)
  • Placenta previa (where the placenta blocks the cervix) or accreta (where it grows too deeply into the uterine wall) in subsequent pregnancies

As you can see, a c-section is not without risks.  Before a c-section is performed, especially in a non-emergency situation, it is crucial to take into account the risks vs. benefits to see if a c-section is really the best option.

Caesarean section

Avoiding a C-Section

Unless you are in a particular high-risk category who would be better served by having a c-section, there are things that you can do to try to avoid one.  These include:

  • Seek care from a doctor or midwife with a low c-section rate
  • Avoid induction, unless medically necessary
  • Arrive at the hospital only once labor is well-established
  • Refuse an epidural (so that you can continue to move around)
  • Ask to try different positions for labor/pushing
  • Hire a doula to help you

These are all ways to help your labor along naturally, when your baby is ready to come, which decrease your chances of having a c-section.

It’s important to remember that it is not always possible to avoid c-sections.  There are cases where they are necessary and they do save lives.  However, it is good to be informed of the risks so that if you are in a non-emergency situation, you can choose carefully.

Have you had a c-section?  Would you?  Why or why not?

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14 Comments

  1. my first child was an emergency c-section because my water broke 6 weeks early and we realized he was breech. to deliver my second child i did a vbac but it was not a pleasant experience.

    i'm very seriously considering having a scheduled c-section for my third child (when that time comes) just because i want it to be as pleasant as an experience as possible. for my vbac, they ended up needing to break my water to help me progress and then 45 mins later i delivered. i had an excellent midwife, a doula, and my loving husband by my side at all times, but still i felt out of control, anxious about the pain and scared. way too fast and furious for me!

    i know that a c-section is not without it's risks, and it's about the only part of my life that isn't consistent with my desire for natural living, but i don't want to dread and fear my next delivery. i want to enjoy and treasure the blessed experience that it is. it's definitely a decision that i will need to make prayerfully.

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  2. Wonderful post. I don't recall now the low percentage rate of the physician that we chose to deliver our first child, but it was either extremely low or non-existent. His episiotomy rate was 1%. He delivered our first child at home with a wonderful, knowledgeable nurse at my side the entire time.

    There are, of course, reasons for some of the "modern" care that mothers receive, but often the old-fashioned natural way is healthier.

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  3. I had a scheduled c-section for kids 3-5. MY first two kids were natural births, however, with my third, she was breech. The doctor try to change her position for over an hour until I just could not take the pain anymore. This was 1 week before her due date, so we gave her every opportunity for the position change. She didn't. I was extremely upset by this and I prayed for days asking God to please not make me have a c-section. I had a c-section, but I was at peace by the time it happened. We attempted a VBAC with #4, but he didn't come on his own after 10 days past the due date, and the doctor told me that inducing after c-section leads to much higher rates of hemorrhaging during labor, so we had another c-section. With the 5th, I no longer had the option for a VBAC because the hospital doesn't carry insurance for VBACs and it was the only hospital our insurance does cover.

    All that being said, the only side effect I had was a bad reaction to the spinal on the 3rd c-section and I actually felt better after the c-sections then after the natural labors. I was more rested and I felt better able to care for my child. That may not be the norm for most, but it was for me. And I really felt God gave me peace over this situation even though I really didn't want the c-sections.

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  4. Honestly 30% seems low to me. Sometimes it feels like all the moms I meet or talk to have had ceasarian births! Something definitely needs to be done in this country to educate women of their power and natural ability to give birth.

    Scheduled c sections are the worst too for babies. There have been so many cases where babies can't or won't breathe because they weren't aware they were born! There's a whole thing that happens when labor starts, beginning with the baby 'telling' the placenta it is ready to go, then the placenta tell the brain the chemicals are released so on and so forth. It's so complicated! And if all that is skipped it can have serious issues for the newborn. For women that desire a csection, though I could never imagine why, I strongly urge them to wait until labor has begun so that the baby is truly ready.

    I do have a sister in law who had sections for both her kids electively. Her reasoning actually makes sense to me! She works out of the home and is basically the main provider fro her family and the company that she worked for at the time granted 3 months off for ceasarian and only 6 weeks off for normal birth! In that case I'd have made the same choice.

    For me getting to push my baby out myself is a wonderful feeling. I have lots of help and encouragement, a midwife who knows how to help and I have really enjoyed all 3 of my normal deliveries, one of which was medicated.

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  5. I gave birth to my son naturally in a hospital. I didn't have any meds except for a little pitocin at the end to pass the placenta (which didn't bother me too much since baby was out) and ibuprofen for a few days afterward! For anyone who wants to go all natural but have no choice about going to a hospital, make sure to find a doctor who has high natural birth rates and who will let you have a port in you arm instead of a constant IV because then you can move around better and it is SOOOO much less painful that way! Also, have a REALLY thorough birth plan made up beforehand and get it approved by your doctor. It is harder to give birth this way in a hospital, but it can happen if you fight for it!

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  6. Thank you for posting this! I just finished reading an article on babycenter.com yesterday about c-sections that left me furious because of all the mainstream garbage in support of sections. I know they are dangerous, not ideal for mom or baby (unless NEEDED) and I wish more moms knew.
    Woman need to take more responsibility for educating themselves from sources outside the doctors office, though. The information is out there and if they were better informed, I bet a lot more woman would say no. They also need to realize that they are in charge – not the doc or the hospital. Ultimately, it is the patient who is responsible for making the decision to induce, be admitted, accept medication or have a c-section. Many don't realize they have the power to say NO because hospitals and docs don't want the inconvenience of woman going against their protocol but no one is looking out for you and your baby like you will. Be prepared and empowered and if possible, avoid hospitals! I am thrilled to be having my 2nd again at a birth center (across the street from a hospital). It is the perfect situation to encourage the best outcome for me and my child with close emergency backup if needed. And WOW is it exhilarating to accomplish giving birth this way. Doctors do not deliver babies, Mamas deliver babies – Go Mamas! 🙂

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  7. Lea — As best I can find, the 30% stat is from 2005. It may be closer to 40% now, for all I know. It's been skyrocketing since 1970 (when it was just 6%).

    Babies born by c-section also don't get the benefit of the contractions and then the actual trip through the birth canal to squeeze the fluid from their lungs, and that's another reason why they may not breathe so well. All in all, unless you have specific risk factors, it's definitely better to go naturally!

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  8. I had an emergency c-section with my third due to placenta previa. While I've always been naturally minded and prefer drug free labor and delivery, I'm certainly grateful to the doctors and the technology that saved my life in that case! I'm pregnant with our fourth now and planning for a v-bac. Having been through all the options: vaginal with epidural, completely natural, and c-section, I definitely encourage others to go natural if at all possible. As other moms who have been there know, its not about being strong or winning medals in the delivery room (in fact, its much more about letting go and relaxing!) but about the amazing feeling as soon as the baby is born. Nothing compares to the rush of natural hormones when you don't have pitocin, epidural meds, etc in your system. I literally felt like I could run a marathon and I was up and showering about 30 minutes after she was born.
    I completely agree with you… c-sections can be lifesaving, and thank goodness they are available in these cases, but for most women, the experience is just better for her and baby to go natural.

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  9. I have had 3 c-sections, and will have the 4th this summer. The first was an emergency and the rest have been scheduled. I often feel failure in this area, but have chosen to be at peace with my circumstances. I was induced at 41+ weeks with the first and my baby was "sunny-side up" and almost 10 lbs, and my labor never progressed. With the combination of fetal distress, high blood pressure for me and other factors I ended up with a c-section. I am sure things COULD have gone differently. But I can't change the past. My next baby was a repeat…in my state you have to be in a level 3 hospital to have a VBAC (we didn't have one in the state at that time though), and it is illegal for a midwife to see you. That combined with the horror of how my first birth went led me to just go with the c-section. If I could go back and change things….you bet I would. But now, I am just choosing to be at peace with it all. Thank you for dealing with the whole c-section issue though! Many of the sites I follow (as I do strive for natural, whole foods living) completely neglect the issue.

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  10. My first was a c-section. I've had 14 years to come to terms with that, and over the years I think I've gained a pretty good perspective on it. Was the c-section necessary? At the point when the decision was made, yes! Unfortunately, I believe that I got to that point because my midwife (a nurse-midwife in an OB/hospital practice) never explained that sometimes prodromal labor can feel like 'real' labor in certain ways (essentially Braxton-Hicks contractions that feel like "real labor" – they're very regular and can even increase in length and intensity, but don't cause any cervical change). I kept freaking out because I had ongoing prodromal labor starting around 34 weeks. They eventually put me on muscle relaxants, but I was so tense and stressed by what I thought was early labor, I believe that stress led to the baby being stressed. Additionally, the muscle relaxants led to the baby having his first bowel movement (meconium before birth). I went in at 36 weeks for a check because I hadn't felt the baby move in 18 hours, and that's when they discovered he was in severe distress. I don't regret the c-section, but I do regret the lack of knowledge and information that led to it being necessary.

    So, to your list of recommendations to avoid a c-section, I would add: INFORM YOURSELF (Preferably before you're in the situation) Quite honestly, after my c-section, I still didn't inform myself, and my 2nd birth was VBAC, but one of the worst possible ways you can have a VBAC. I actually vowed I'd never get pregnant again after my 2nd was born, because not only was the experience terrible, but it messed up our bonding and relationship for a long time. It took 4 long years of reading, learning, praying, a chance internet search and God being the one in charge of when/why/whether I get pregnant to really change my mind. I spent hours each day of my pregnancy with my 3rd researching and arming myself with the information I really wished I'd had before I ever got pregnant with my 1st. I was able to go on to have 2 more babies VBAC, but at home, with a CNM; both of those births were amazing. The only way to get there was do get to the point where I actually/truly knew and trusted my body.

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  11. I'm having a Christmas/New Year's Baby, which is one of the (many) reasons I am having a midwife rather than an OBGYN. A cousin and a childhood friend both gave birth over the holidays last year. My cousin, going with hospital birth, was induced and sectioned on Christmas Eve…convenient much? My friend, with her midwife, was told to relax and enjoy the holiday, and that the baby would 'get here when it gets here'. I much prefer the midwife's sentiment. People seem to forget that a caesarean is MAJOR SURGERY. I would prefer very much to avoid recovering from surgery during the newborn stage.

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  12. After helping my daughter get through her pregnancy as healthy as possible, it didn't turn out like we expected. Labor started, nice and easy. We made it nicely through the day, sat with our 18 yr. old dog while she passed on and timing contractions. Took a family walk on the pier, and watched sit coms on dvd's of people having babies comically. We arrived at the hospital, the midwife was mean, she disappeared to eat while the baby was flatlining. The wonderful hospital team saved the babies life. My daughters a candidate for a VBAC, the baby had the cord wrapped so many times that it would not let him come down the birth canal. She had a spinal block since they were able to get the babys heartbeat back, which allowed me to be present. I watched the whole thing, and he was sunny side and arrived looking right at me. He is now 28 mos., a joyful redhead. So, despite the best birthing preparation and knowledge it doesn't always work out. She was very disappointed, and felt that the labor was a waste of time. I told her that it readied him for birth and breathing. They spent two days in the hospital. Not everyone is able to be at home. Each person should take a good birthing class, ours was wonderful. My 4 kids all came naturally, nonmedicated and quick. I just assumed at the time that everyone would want to do it that way. It never occured to me to have needles or drugs or an episiotomy. I guess I just got lucky with the doctors I had letting me walk the halls and dance my way through contractions.

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  13. My daughter ended up being delivered through emergency c-section. I had to be induced because of being 2 weeks late and gaining 30 pounds in water weight in those two weeks plus my blood pressure shot up. After 18 hours of labor my midwife realized my daughters head was stuck horribly. There was no way to safely adjust her so she could be birthed. I believe that the c-section saved her life. I’m pregnant now with what would be our third. Ended up miscarrying with the last one. My midwife doesn’t believe I’ll be able to have a natural birth but we will see.

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  14. I wondered if you knew anything about knots in umbilical cord. I was induced at 39 weeks because I ended up with gestational diabetes and the doctor told me that my placenta might give out after 39 weeks. With that and the fact that I had an anterior placenta and didn’t feel my baby kick as much as I should have. I was afraid and went along with it. My baby was in distress after they started the induction so they went ahead and performed an emergency c section. But what they found was a knot in the umbilical cord. I often wonder, if I was wiser ;), and maybe had done things differently and avoided the induction (which I’m not sure was necessary, my baby was only 7 lbs at birth) if baby’s with umbilical cord knots survive a natural delivery. I’ve looked online but am not really finding any statistics.

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I’m Kate, mama to 5 and wife to Ben.  I love meeting new people and hearing their stories.  I’m also a big fan of “fancy” drinks (anything but plain water counts as ‘fancy’ in my world!) and I can’t stop myself from DIY-ing everything.  I sure hope you’ll stick around so I can get to know you better!

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