In honor of cesarean birth awareness month, I’d like to shed some light on this important birth route that is shared by approximately 31.7% of birthing people across the U.S. (CDC.gov). Cesarean birth is a surgical procedure that can be performed quickly during emergency situations to deliver a baby through incisions in the abdomen and uterus. It may also be a scheduled and expected mode of delivery for a variety of reasons. To start the ball rolling, let's discuss planned, unplanned and emergency cesarean births and why they may be performed.
According to the American College of Obstetricians and Gynecologists (ACOG), the following situations are some of the reasons why a planned cesarean birth may be performed:
Multiples pregnancy (*of note, twins CAN be born vaginally, depending on the case)
Problems with the placenta - i.e. low lying placenta
Previous cesarean birth (*VBAC, or vaginal birth after cesarean may be a possible option, see below).
Baby in breech presentation, transverse lie
Maternal and/or fetal medical conditions (i.e. diabetes, preeclampsia, active herpes)
An expected very large baby
An unplanned cesarean birth might be performed due to:
Failure of labor to progress
Concerns with fetal heart monitoring/fetal distress in labor
Baby moving into a position making vaginal delivery extremely difficult
Much rarer, but emergency cesarean births may be performed due to:
Umbilical cord prolapse
(Cesarean Birth | ACOG, 2018)
Can I choose to have a planned cesarean birth, even if I'm a candidate for vaginal delivery?
Yes, you can discuss having a planned cesarean birth for your first delivery (this is known as a primary cesarean section) with your provider as it is within your patient rights. However, it's important to understand the risks and benefits of both delivery options. Be sure to engage your healthcare provider in a thorough discussion to uncover and potentially alleviate some fears or other variables that may be impacting your decision if this is your first time delivering.
Planned Cesarean Birth Benefits:
Convenience of scheduling, if planned - minimizing home interruptions or childcare concerns if other children are at home
May enable birthing person to choose their delivery provider due to scheduling
May offer a more controlled environment for birth than the unknown of how long labor may be
May reduce some risks of labor for the birthing person and baby
Cesarean Birth Risks:
Cesarean birth delivery may be a request of some expecting families, even when vaginal delivery is an option. Due to potential risks and complications, this type of request should be discussed in thorough with one's healthcare provider to ensure that the birthing person is fully informed. Why is this so important? Because though there are potential risks and complications of either mode of delivery, cesarean birth can carry greater risks of complications compared with vaginal birth for both mom and baby with regard to things such as:
Risk of injury to other organs including bowel, bladder
Greater risk for blood clots
Potential for reactions to medications or anesthesia used
Complications for baby can include: breathing problems, surgical injury, greater potential for delayed breastfeeding
(Mayo Clinic, 2021).
Are there any tips for reducing my risk for needing an unplanned cesarean birth? Lamaze International offers some tips, as described below:
Choose a healthcare provider with a lower cesarean section rate, and who supports normal physiologic birth whenever possible
Take a comprehensive birth preparation class , such as STRONG AS A MOTHER'S CHILDBITH PREP CLASS. I offer 3 different online formats to fit a variety of schedules and learning needs. I also offer private consultations to focus on you as an individual! Learn more at www.strongasamother.net/bookclass
Find out the cesarean birth rate where you are planning to delivery (both primary rate and repeat cesarean section rate)
Avoid induction of labor that is not medically indicated
Bring a trained labor support person with you to your delivery (like a birth doula)
Enter your pregnancy in good health and maintain appropriate weight gain
Labor at home as long as possible
Change labor positions often, try using upright forward leaning positions
(Cesarean Surgery, n.d.).
What are some expectations for recovery after a cesarean birth?
Expect to stay within hospital setting for 72-96 hours post delivery - this can be exhausting for new parents, with frequent staff interruptions
Expect to need help on hand for several days after birth - including at home
Delegate household chores/cooking to other family, friends
Rest when you can
Expect to see your healthcare provider at 2 weeks postpartum and again at 6 weeks postpartum for an overall health and incision check
To reduce risk of blood clots, move around as soon as possible after delivery - be mindful of asking for and taking pain medication if needed to help you achieve this
Expect to experience postpartum vaginal bleeding from 3-6 weeks post delivery
Expect not to resume normal exercise or activity until cleared by your HCP, generally 6-8 weeks post delivery
Expect incisional pain for the first few weeks.
Monitor for signs of infection such as redness, incisional drainage that smells foul, fever.
Tips for a Family Centered Cesarean Birth:
Ask if a clear drape is available to see your baby being born
Ask for skin to skin in the operating room or as soon as possible - if you are unable to do so, see if your partner can initiate asap
Initiate breastfeeding as soon as possible
Room in with your baby during your hospital stay
Play music via headphones or speaker
Ask for your partner to take pictures and/or video of your birth
Considering Vaginal Birth After Cesarean Section (VBAC) - Am I a candidate?