Having a c-section birth experience can bring up a lot of emotions, feelings, and questions about your body, birth, and your future birth options. Many women who have had a cesarean eventually find themselves asking whether or not their cesarean was medically necessary. In this blog post, we are going to explore common reasons for cesareans and which ones are "medically indicated" and which could have been prevented.
Disclaimer: Please keep in mind this article is intended to serve as an informational resource only, and is not intended to substitute for medical advice. Please consult your health records, healthcare provider, your intuition, and God to make decisions regarding your own birth choices.
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Cesarean Rates in America
In the United States, the cesarean birth rates hover around 30%, meaning 1/3 of births in the United States are via cesarean. The World Health Organization (WHO) has stated that population cesarean rates above 15% are not associated with better overall maternal and neonatal outcomes, meaning that approximately half of the cesareans performed in the United States may be unnecessary. Considering the growing maternal health crisis in the United States, unnecessary surgical birth is extremely concerning. Before we discuss the common reasons for cesarean birth and whether or not your cesarean was necessary, lets learn a little more about c-sections in America.
Benefits and Risks of Cesareans
While the intention of this article is to highlight the phenomenon of the "unnecessarean", it is critical to acknowledge that Cesarean Section Births do have a time and place and can be medically appropriate. It is critical, also, to understand, that without knowing your entire story and medical history, I cannot infer that your cesarean was unnecessary, so I need you to understand that I'm not implying that in any way. Before we dive into how necessary or unnecessary a c-section may have been, lets discuss the benefits and risks of cesarean birth.
C-sections can save lives. Sometimes during birth an emergency can arise in which immediate birth is necessary for the survival of the infant and/or mother. In this situation, we are so grateful that cesareans are an option. For others, anatomical concerns, trauma concerns, and other risk factors could lead to the decision to plan a cesarean birth for the safety of mom and baby. The problem with c-sections arises when we misapply the concept of the life-saving cesarean to all birth, assuming that cesareans are a somehow "more controlled environment". Unfortunately, the opposite is true.
Cesareans come with higher risks for the following conditions:
Breathing Problems for Baby
Future Bladder Problems
Future internal organ complications due to scar tissue
Placenta Accretta in future pregnancies
What is marketed as a totally routine procedure can have dramatic and unexpected complications that impact you for a long time, maybe even a life time. With this in mind, it is extremely critical to insure the reasons we are opting for cesareans are, in fact, going to be life saving.
Unfortunately, too often do I connect with mothers who share that their cesarean was deemed a medically necessary emergency, however they were either lied to and there was no emergency, they were not provided with alternative management options, or the emergency was created by inappropriate use of labor interventions.
Without being a medical provider, though - heckkk, even as a healthcare professional -- it can be tricky to tell when something is seriously an emergency, or if there could be an alternative approach. Let's discuss common reasons for cesareans and whether or not they warrant a cesarean as standard protocol.
Common Reasons for Planned C-sections
Placenta previa is a condition where the placenta is covering the cervix. Most cases of partial or complete previa are noticed and diagnosed at the 20 week anatomy scan. In many situations, though, this is not the time to resign yourself to a planned cesarean. Your provider will re-check the position of your placenta via ultrasound around 32-34 weeks to see if the situation has resolved. Often, as the uterus grows, the placement of the placenta shifts, moving it away from the cervix, allowing for safe vaginal delivery. If placenta previa is not resolved before birth, it is important that a cesarean section is planned, ideally before labor starts naturally, as a dilating cervix covered with a placenta can create a hemmorhagic emergency that could also result in decreased oxygen to baby, creating an emergency.
Small Pelvis / Big Baby
Some women are told they will need a cesarean because their baby will be too large to pass through their pelvis OR because their pelvis is "too small" to allow a baby to pass through. Check out this post answering the question of whether or not you should schedule a cesarean for a predicted large baby. Regarding the "too small pelvis" or "too petite of a woman" reason for a cesarean. This is bogus. While it's certainly possible that some women could, in theory, have a harder time giving birth due to anatomical differences, the truth is, this cannot be dependably predicted prenatally. The pelvis shifts, changes, and OPENS so much during a physiological labor, that your pelvis today can not predict how your pelvis will "behave" during labor.
Breech Baby is probably one of the most common reasons women are sheduled for a cesarean (okay I just said that based off my own biases... but I'm sure it's up there on the list!) The truth is, breech presentation can be a variation of normal and can be born vaginally. I'm no expert on breech birth, but Dr. Stu Fischbein is and he's been traveling the country with the mission to re-teach breech. The truth is, your OB isn't scheduling a cesarean for breech becuase you can birth a breech baby... it's because they were never trained in managing breech birth and don't know what to do (or not do).
Previous Cesarean Section
As the old adage claims: "Once a cesarean, always a cesarean"... but this is a myth that has been proven totally false, except in a select few situations (for example, having a classical uterine incision is a contraindication to VBAC). The truth is, Vaginal Birth After Cesarean is an option for most women. If you're hoping for a VBAC, it's important to learn the truth about planning your VBAC to ensure you have the best chance of having a positive birth experience.
Common Reasons for Emergency Cesareans
A common reason for an emergency cesarean is fetal distress. Fetal distress is often identified if the baby's heart rate either decelerates beyond the normal range OR increases beyond a safe range, for an extended period of time, and cannot recover, even with position changes and oxygen. Fetal distress can be caused by placental problems, maternal or fetal infection, as a side effect of medications like pitocin, from meconium ingestion, cord compression, and other factors.
Placental abruption is when the placenta begins to separate from the uterine wall prematurely. This will typically be noticed from profuse, bright red vaginal bleeding. Occasionally, placental abruption can occur during pregnancy and resolve itself, other times it constitutes an emergency. Whether or not your situation is bad enough to warrant a cesarean should be discussed with your obstetric health provider.
Umbilical Cord Prolapse is when the umbilical cord enters the birth canal before the baby's head. This is an emergency situation that requires and immediate delivery. This typically occurs if the mother has a high volume of amniotic fluid and the baby has not descended to apply pressure to the cervix firmly or if the amniotic sac was ruptured before the baby's head was engaged in the pelvis.
Uterine Rupture is a condition when the wall of the uterus separates, creating an emergency for both mother and baby. Uterine Rupture risk is associated with women who have a scarred uterus from a previous uterine surgery or cesarean birth. Uterine Rupture can disrupt oxygen delivery to the infant, requiring immediate delivery via cesarean. It is critical to understand the difference between uterine rupture and uterine dehiscence when researching uterine rupture rates and VBAC.
Failure To Progress
Failure to progress is the term providers use when a woman dilates slowly or "inefficiently". Failure to progress, however, is a symptom of a problem, not a condition in itself. Typically, failure to progress could be better described as failure to wait, as the cause of slow dilation is typically an unsupportive provider, unsafe environment, Fear Cycle, or poorly positioned fetus. These issues can often be remedied with quality emotional and physical labor support often received by a trained doula. If you had a cesarean for "failure to progress", it is likely that shifting certain circumstances around your birth story could have resulted in a different outcome. If you are wondering what can be done for a better experience in a future birth, I often work with women to debrief their cesarean birth and prepare for their future VBAC with a goal of not repeating the "failure to progress" experience over again.
Cephalopelvic disproportion aka CPD is a common "diagnosis" for why a woman needed a cesarean. These women are often told they'll never give birth vaginally... and many of them go on to birth larger babies vaginally without complication... why is this? Often, the diagnosis of CPD comes from the belief that the baby's head is too large to pass through the mother's pelvis. However, this is rarely a true phenomenon. More often, the issue is positional: Either baby's position or mom's position. If the baby is in a less than ideal position, it can be difficult for baby to descend. Sometimes, even if baby is head down and anterior the way we expect, they could be just slightly acynclitic (aka not straight down)... OR... it could be possible that the mother's body prefers the baby's to be occiput posterior (aka OP or "sunny side up"). While some believe OP positioning is responsible for cesareans, I think the truth is some women's body's need their baby to be one way, and others need the opposite. Some women birth OP babies without issue and struggle with OA babies. Moreover, mom's labor and birth positions MUST be conducive to the descent of the fetus. If the mom's pelvis can't open properly, the baby will not efficiently descend, which can lead to exhaustion for mom, distress for baby, and often gets labeled as a "mom's body is broken" problem.
Was your cesarean necessary?
Knowing whether or not your cesarean was necessary can be tricky. Most of these situations could have components that make a cesarean absolutely necessary while another woman could have a similar condition but still give birth vaginally.
One thing to consider is the possibility that your body is fully capable of giving birth vaginally, however an attempt to control labor with medical intervention resulted in a true emergency, that could have been avoided by avoiding the interventions. It is for this reason that many doulas and mothers are such loud advocates against elective labor inductions. While labor induction can be medically indicated and result in a totally healthy birth, the introduction of medically unnecessary interventions can open the door for emergencies that may not have occurred otherwise. If you believe that your cesarean was unnecessary or preventable, and you are dreaming of a Vaginal Birth After Cesarean that leaves you feeling empowered and joyful, check out the variety of Free VBAC Resources available to you today!