When it comes to birth, there are 2 ways that your baby can come out; vaginally or via Cesarean. The best outcomes for mother and baby tend to come with a vaginal delivery, and because of this, Cesareans can sometimes get a bad reputation. This is unfortunate because sometimes there is a bit of a stigma placed on women who have a Cesarean delivery. Sometimes it is placed on them by other people (especially with a planned Cesarean), and sometimes women place that stigma on themselves (particularly with an unplanned Cesarean). As with most interventions, Cesareans are there for a good reason, however like other interventions they are also very overused. I have heard some very good reasons and some not so good reasons for surgical birth, but regardless of the reason, there are a few things you should know about Cesareans before going into your birth.
What is a Cesarean?
A Cesarean section or a Cesarean birth is the delivery of a baby via an incision in the mother's lower abdomen/pelvic region. A Cesarean is most often an elective surgery, but is best used as a life saving operation when the mother and/or baby are at risk. When a Cesarean delivery is an emergency, the mother will be on the operating table and the baby will be delivered within a matter of minutes. Everything will be a whirlwind and move very quickly. For most surgeries, there is a little more prep time.
First the mother is given an epidural if she doesn't already have one. In an emergency, if she doesn't have an epidural placed, she will be placed under general anesthesia meaning she will be asleep for the surgery. Once the epidural is placed, she will be taken back to the operating room. The partner is given special clothes to put over their own to create a sterile environment in the OR. Once in the OR, a sterile drape is placed over the mother to lower the risk of infection. Next, her belly is swabbed at the incision site with a cleansing solution. There will be tests done to make sure that she feels no pain. Often they will touch her with an ice cube or poke her with something to see if she feels it. During the surgery, the mother will likely feel some tugging feelings, but should feel no pain. Once they are fully prepared, the doctor, usually an obstetrician, will make the incision. There are a few different types of incisions that may be made. The majority of Cesareans have a low transverse or "bikini" incision. This is very low in the pelvic cavity just above the edge of the bladder. The "classic" incision is a vertical incision higher up on the belly, closer to the belly button. This is generally reserved for emergencies or very preterm babies. There is also the low vertical incision which may be used for a baby in an awkward position. It is a vertical incision made lower than the classic incision, in the pelvic cavity rather than the abdomen.
Once the surgery has begun, the baby is generally delivered within the first 5-15 minutes. The remaining time is spent on closing the incision. Altogether a Cesarean delivery usually takes between 45-60 minutes from beginning to end. Once the surgery is complete, the mother is moved to a recovery area before being taken to her postpartum room.
Let's Talk Statistics
There are a lot of statistics surrrounding birth that you may not be aware of. Let's take a look at some of the numbers surrounding Cesareans.
According to the Centers for Disease Control (CDC), there are more than 1,000,000 Cesareans performed every year in the United States making up 32.2% of all births.
The World Health Organization (WHO) recommends that the Cesarean rate be between 10-15% of all live births. This is between and not under because the rate of major complications is between 10-15%. This means that a Cesarean rate to match is a good sign. Any higher or lower indicates poor health care.
The rate of maternal mortality (the mother dying) is about 4 in every 100,000 vaginal deliveries, vs. 13 in every 100,000 Cesareans. This jump in risk for the mother is due in large part to a higher rate of hemorrhage (bleeding out), higher rate of infection, and complications from anesthesia during surgery.
According to the CDC, the rates of complications such as maternal transfusion, ruptured uterus, unplanned hysterectomy, and ICU admission are remarkably lower in mothers who have only given birth vaginally. The rates go up for those women having a Vaginal Birth After Cesarean (VBAC), but they are still lower than the rates of these complications for mothers going in for a primary or secondary cesarean. Check out the numbers for each intervention here.
Anecdotally, a survey in the United States found that first time mothers who gave birth via Cesarian were much more likely to report feelings of being frightened, overwhelmed, and helpless, as well as reporting not feeling capable, confident, powerful, and unafraid during birth. Again, this is anecdotal evidence reported by first time mothers about how they felt about their experience.
Cesareans DO NOT Equal Failure
This is very important. If you have attempted a vaginal delivery and wound up in surgery, you have in no way failed. You have not failed your baby. You have not failed your partner. You have not failed yourself. One thing that is very common for women to feel is that they have failed. As women we are supposed to be able to give birth to our own babies, and in going into surgery, you have been unable to accomplish a task that should be a basic part of being a woman. Many women feel this way. Sometimes things happen that make it impossible or unsafe to deliver vaginally. Sometimes the placenta grows over the cervix and the baby can't get out. Sometimes the baby is sideways and won't turn. Sometimes infection can develop and we start to worry about the health of mother and baby. Sometimes a woman's blood pressure climbs dangerously high during pregnancy threatening her life and the life of the baby. Sometimes trauma or abuse has caused emotional scars that make the mere thought of going into labor unbearable. Sometimes you have been in labor for so long that your exhausted body is not able to keep going. There are a lot of good reasons to give birth surgically, and none of them are failure of the mother or the baby. There are also very bad reasons to have a Cesarean such as inaccurate estimate of size, the mother "taking too long", the doctor not wanting to work on a holiday, and so on. I consider most of the bad reasons to have surgery more a failing of the care provider and not of the mother.
Cesarean Birth IS Birth
Like the feeling of failure, it is very common for mothers who have had a Cesarean to feel as though they have not given birth to their baby. This can be perpetuated by language, particularly when people talk about the baby being "taken" or "removed". Surgical birth is still birth, and it can still be a very rewarding and positive experience. Unfortunately it is not always positive and can cause trauma and even postpartum post traumatic stress disorder. If you are experiencing symptoms of PTSD, there are therapists who specialize in working with depression and PTSD following birth. Please seek them out. There is no shame in getting help when you need it.
You Still Have Options
Many women may not be aware that although going into the operating room, they still have options. In an emergency, these options become fewer. When life is actually on the line, some concessions must be made. However, there are many instances where a woman may find herself going into a surgical birth that is non emergent, and in this case, she can absolutely make certain requests.
The idea of providing options to women in surgery is fairly new, and many hospitals still balk at the idea, however, an increasing number of them are providing women with a more pleasant experience even in the operating room. Many women are even opting for a procedure called a gentle cesarean. Here are some of the options that you may have in the OR:
The recovery from surgical birth is very different than recovery from a vaginal delivery. Here are a few of the things that you may experience after a Cesarean, some of which are also common after a vaginal delivery as well:
What Does This Mean for your Future?
Delivering your baby via Cesarean Birth may have impacts on your future that you may not be aware of. When you agree to a Cesarean delivery, the doctor and anesthesiologist will come into the room with papers for you to sign and begin listing off complications and side effects. Most women are in no position to be listening to and processing this information, and are often caught unawares when these things come to fruition. Here are a few things that you may experience even years after a Cesarean Birth. These things are not experienced by every woman, but may be experienced by many.
In conclusion, a Cesarean delivery can be a life saving procedure for both the mother and the baby when it is indicated. Emergencies happen, and when they do, we are glad that medicine can help to save lives. However, there is a bit more risk when going into surgery, so it isn't something that should be entered into lightly. Many women have lovely experiences with their Cesarean births and recovery afterward, but there are also mothers who have very negative experiences. Understand that you have options, and I generally recommend that people prepare themselves for the possibility going in that things may not go as planned. When you are pregnant, make sure to understand what having surgery would mean, take a look at your options but don't dwell on it, and understand what you would need to change during recovery. Then if it happens, you are a bit better prepared which can help you to not feel overwhelmed.
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