Wednesday, February 17, 2010

Medical and Non-Medical Reasons for Cesarean Births

An Elective Cesarean section is a planned C-section, as opposed to an Emergency Cesarean section which is performed during labor.

Note: It is much better for mom and baby if a C-section is not performed until labor has begun spontaneously. This way you know for sure the baby is ready to be born and the hormones that help with birth, breastfeeding, etc have begun flowing. 


Why Doctors and Mothers choose Elective Cesareans for Non-Medical reasons:

1. The woman's pelvic floor will remain undamaged and this will save her from being incontinent of urine or feces.
To assume that stretching the vagina, one of the things it is made to do, will cause permanent damage is a misleading assumption. Studies have found that by middle age, there is no difference in the rate of incontinence among women who have had cesareans, vaginal deliveries, or those who have never given birth.

2. A desire to avoid the stresses and complications that might arise in a vaginal birth, such as long duration, exhaustion, fetal distress, the need for forceps or vacuum extractor. They perceive the potential for these risks to be more frightening than those accompanying cesarean birth.

3. Social reasons - convenience control over timing, apparent simplicity (scheduling it and baby is born in an hour).  This is really more convenient for the doctor, who is done in an hour, than for the mother who must recover for weeks. This is based on lack of information about risks of cesarean sections and the length and hardships of recovery.


Why Doctors and Mothers choose Elective Cesareans for Medical Reasons:

1. Doctors suggest the fearful possibilities that the baby will be too large to deliver vaginally, a failed induction can lead to an unplanned cesarean anyway, you may have a delay in getting an epidural and have to suffer pain, your labor is overdue, or the possibility of a uterine rupture during a VBAC (if mom has had a previous Cesarean section). Even if doctor coerces the mother into choosing a cesarean for these reasons, it is written down in her paperwork as "maternal request."

2. A breech baby (legs and/or butt first). Breech babies can be turned during pregnancy (ie, external version, I'm planning a post on this soon) or even during labor. Even un-turned breech babies can be delivered vaginally, but many doctors won't allow it and insist that if a baby is still breech at the due date than a C-section is necessary.
Obstetricians debate whether Cesarean section is always best for Breech babies (Washington Post)

3. Mother has a serious illness (heart disease, diabetes, preeclampsia) or injury.  Sometimes the doctor will allow the mother to attempt to labor under supervision.

Why Elective Cesareans are Riskier than Vaginal Births, International Cesarean Awareness Network (ICAN)




Medical Reasons for Cesarean Birth:
Although cesareans are not always necessary in these circumstances, they are almost always considered and very often performed.


1. Emergencies:
- Prolapsed Cord
- Serious hemorrhage (excessive bleeding) in the mother.

2. Arrested Labor/Failure to Progress:
* Note that when the doctor decides you have failed to progress may actually mean he just thinks you are taking too long, such as at the 8 hour mark, or when his shift is almost done for the day. (Recall that birth can take 24 or more hours).  Experts agree that far too many c-sections are performed for failure to wait. *
- Abnormal presentation of baby
- Inadequate uterine contractions
- A poor fit between baby's head and the mother's pelvis (sometimes given as a reason ahead of time, but is difficult to measure or predict)

3. Problems with the Fetus:
- Fetal distress. This is indicated by what the fetal heart monitor records or by checking the amniotic fluid for meconium (when baby is stressed it poops). It is another reason that frequent unnecesareans are performed, as the monitor can be wrong or interpreted incorrectly.
- Pre or post maturity.

4. Problems with the mother:
- A genital herpes sore
- A previous cesarean section and the VBAC is not going well


 
     "Cesarean rates are up to 50 percent or higher in some hospitals. Doctors often feel they must do a C-section to protect themselves from a malpractice suit. And many of them seem to feel that a C-section is actually better than vaginal birth. A lot of women are being given unnecessary surgery."
     "I had a C-section, but in my case it was necessary."
     "Tell me about it."
     "Well, the baby's heart rate started to drop on the fetal monitor, and the doctor was worried that she wasn't handling labor very well. So he said a C-section was the safest thing to do."
     Its an awkward conversation to say the least. I would never want to make any woman feel bad about the birth of her child... Having been told by both a doctor and a reliable-looking and expensive piece of machinery that her baby could be in trouble, my acquaintance probably made the best decision she could make in that moment. By the time sh reached the point when that decision was made, it could, in fact -- after hours of beeping noises on the fetal monitor, the suspense of the hospital atmosphere, and loads of chemicals pumping into her body -- have been the only choice available.
     Some percentage of women who think their C-sections were necessary -- because of fluctuating heart rates, large babies, failure to progress, previous C-sections, difficult birth positions, and on --- have actually had unnecessary C-sections. I know this because the World Health Organization says that any time a country's cesarean-section rate rises above 15 percent, the dangers of C-section surgery outweigh the life-saving benefits it is supposed to provide. In the US the overall C-section rate has now reached [over] 30.2 percent. -- From Cesarean Birth in a Culture of Fear, by Wendy Pointe

3 comments:

mark moran said...

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C-Section ‘must have’

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It is often said that the best ideas are the simplest, and here is a perfect example of that statement: The Hydrant - a personal, hands-free drinking system for people who are bed or chair-bound that makes it easy to get a drink without calling for help. The unique clip mechanism enables The Hydrant to attach easily to beds and chairs thus giving the user instant access to fluids without having to reach out.
It is proving invaluable for new mothers during birth, afterwards in recovery where soreness makes it uncomfortable or difficult to move for a while, and then at home whilst breastfeeding. It is extremely useful for those who have had a Caesarean Section where The Hydrant should be a ‘must have’ item for the benefits it brings.
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The Hydrant was the most useful thing in my hospital bag. I was in hospital for a week and if I had been dependant on the hospital water jugs I would certainly have become dehydrated. Being able to attach the Hydrant to the bed was really helpful as we were moved rooms so often and the bed was moved with me. Having had a caesarian the Hydrant was a godsend with helping my recovery. All the midwives and doctors were very impressed by the Hydrant as a way to monitor patients fluid intake. Back at home the Hydrant has really helped me to breast feed, its all too easy to become dehydrated even if you remember to get a glass of water before each feed its often out of reach! I highly recommend it for all expectant mothers.
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Mrs. W. said...

Anthrodoula - It would be nice if you did not start with the premise that cesarean sections are bad, and that women who are choosing them are doing so from an uneducated standpoint. Most women who choose a cesarean, particularly those who are doing so absent a medical reason - have thought about the choice extensively, have had to advocate for themselves and defend their choice with their care providers and a myriad of others.

A better way to look at it is that having a baby can only happen two ways - planned vaginal delivery and planned cesarean delivery. Both birth plans have risks and benefits. Women who choose cesarean are choosing the risks of cesarean because they prefer those risks to the risks of a planned vaginal delivery. Women who choose planned vaginal delivery do so because they prefer those risks and benefits.

You mention that some women choose cesarean in order to protect their pelvic floors - and then you discount that reason, as the differences may disappear later in life. The thing is there is a lot of years in between child-bearing and later in life - and preserving pelvic function during those years is not without value.

Anonymous said...

Please amend your article to include instances of placenta previa. I had wanted a vaginal delivery but an unresolved previa at 36 weeks makes it no longer a possibility. I found your site searching for information on using doulas during planned c-sections and while I enjoyed reading your article on that topic, this article leaves me feeling frustrated and sad again about my impending c-section that I can do nothing about. You've listed 1 or 2 examples of emergencies that require a planned c-section but nothing about placenta previa which I think is a special case in the c-section vs vaginal birth debate. I'm very very happy with my experience with my OB managing my previa and I think it's one that other women should strive for if they find themselves in the same situation. After diagnosis at 20 weeks he checked again at 32 weeks. No resolution. He gave us another opportunity to check at 36 weeks (yesterday - still no resolution) and was very reassuring and wonderful in explaining to me the risks and benefits in scheduling the c-section. My lovely doula has also been a great support through all of this and I'm excited about having her there when baby is born. All together they've made me feel joyous and excited about my baby's coming birth despite the fact that I know it won't be as originally "planned". I just want it known that that IS possible and not all c-sections are or should be faced with fear or shame.

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