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:
Placental abruption
Uterine rupture
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
(Berghella, 2021).
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:
Infection
Blood loss
Risk of injury to other organs including bowel, bladder
Greater risk for blood clots
Potential for reactions to medications or anesthesia used
Longer recovery
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?
The more cesarean births an individual has, the greater the risk factors are for potential medical complications and problems with future pregnancies. Because of this, it is important to know that approximately 90% of individuals who have had a cesarean birth are potential candidates for vaginal birth after cesarean delivery (VBAC), making this a viable option for many birthing people(Vaginal Birth After Cesarean: VBAC: | American Pregnancy, 2019). According to the Mayo Clinic (n.d.), VBAC was successful in about 70% of those who attempted a trial of labor after cesarean (TOLAC) after one previous cesarean section in 2013. It's no wonder that more birthing people are choosing to explore this option for their deliveries. With this said, your individual risks should be assessed in depth with your health care provider.
Eligibility factors for VBAC according to American Pregnancy Association include:
Those with no more than 2 low transverse incision cesarean deliveries
No additional uterine scars, uterine anomalies
No history of previous rupture
Your health care provider should be prepared to prepared to monitor you for cesarean delivery, and should be readily available to perform one if necessary
Contraindications to VBAC:
Prior classical or inverted T scar on the uterus,
History of uterine rupture
Current pregnancy with a placenta previa
Baby in a transverse lie position
VBAC Benefits:
Avoidance of surgery and it's potential complications
Shorter hospital stay
Shorter postpartum physical recovery
Avoidance of risks for placental problems if planning for other future pregnancies
VBAC Risks:
A failed trial of labor after cesarean section may lead to more complications, the greatest risk being potential for uterine rupture - which is life threatening for you and your baby. Risk for uterine rupture is generally less than 1%(VBAC: Know the Pros and Cons - Mayo Clinic, n.d.). A uterine rupture is where the surgical scar on the uterus breaks open. This risk may be increased in cases of induction of labor after cesarean birth (Dekkar, 2020). For an in-depth dive into this topic, check out this link: evidence based birth.
A Planned Cesarean Birth Story - shared by labor nurse Kristin, as told to Lauren Cascone
Below, I wanted to share the story of a planned cesarean birth story from a mother’s point of view. Today’s interview responses come from a mother who just happens to also be a rock star, seasoned veteran labor nurse. Read on as Kristin shares with us her birth experience and all that came along with it, including how she prepped, how she felt, and what she took away from the experience.
1. Was your cesarean birth planned or unplanned? If planned, would you mind sharing why?
My c-section was a scheduled primary cesarean for breech presentation. After going through so much to conceive and finally becoming pregnant through IVF after 3+ years of trying I was not comfortable having my doctors attempting an external cephalic version- where the doctors try to externally push on your belly to rotate the baby. I saw a chiropractor and did some stretches and exercises to help coax her back into a vertex position but ultimately I felt like if she was breech then maybe it was for a reason.
2. Coming from a background as an experienced labor and delivery nurse, how did you feel about needing a cesarean birth delivery? Were there any apprehensions, fears, concerns about postpartum recovery?
Honestly, at first, I was pretty devastated. Like I said, we had been through so much to get to this point and I had run through a lot of scenarios in my head but for some reason the baby being breech never crossed my mind! Silly me! I felt I was being “robbed” of experiencing labor, even if a vaginal delivery wasn’t promised. After having time to accept the reality of how our baby was going to be delivered, it was pretty nice to be able to know who was going to perform the surgery, administer the anesthesia and be the nurses taking care of me and our baby! I tried to look at all the positives surrounding a scheduled cesarean. As a L&D RN I knew what to expect regarding c-section recovery so I stocked up on ibuprofen, acetaminophen, (*for pain relief) simethicone, (*for gas discomfort) and colace (*stool softener). I also prepared my husband for everything to expect as well.
3. Would you like to share an overview of your cesarean birth story with our readers?
I definitely do not want to scare anyone about any type of delivery but my c-section was anything but normal or routine. Yes, I had a scheduled primary cesarean section for breech presentation. Yes, like I said, I was able to choose my surgeons, anesthesiologist and nurses (work perk!) to take care of me. From the time my daughter was delivered, one foot at a time, absolutely nothing went as planned or as I could have expected.
Our daughter Avery didn’t breathe right away and needed resuscitation but then appeared to be stable. I knew she would have to be admitted to NICU because of that but had the upmost trust in our NICU team that she was in the best hands. As amazing as my workplace's Level III NICU team is, Avery ended up having a very rare complication called pulmonary hypertension and she did need to be transferred to Columbia Presbyterian for this medication. Thanks to the quick diagnosis and incredible treatment she received where we delivered, she made a miraculous and very speedy recovery at Columbia and was off all breathing support 24 hours after her delivery. We are SO thankful to all the amazing people who cared for us during this scary and traumatic time.
What I hope people can take away from my scary and thankfully uncommon birth story is that you really need to find providers and a hospital that you trust. Even as a L&D nurse I thought I had gone through every worst care scenario in my head. Clearly I never would have imagined this would happen to us and it was very traumatic but I trusted my team 1000% and knew they would give us the best care possible.
4. Having now had a cesarean birth are there parts of your experience that have impacted the way you care for your cesarean birth parents during their delivery and initial postpartum time on the labor unit?
I definitely am more conscious of explaining the process of a c-section (both scheduled and unplanned), to help ease anxieties of parents. I knew the process and it still was scary! I also try to get the baby over to the parents as soon as I safely can so they can start bonding right away.
5. What advice do you have for moms who are planning to give birth and may have a planned or unplanned cesarean section delivery?
As a labor nurse, I know that no vaginal delivery is promised until the baby is safely delivered. For any mom preparing for delivery, I think it’s important to know your options and educate yourself so you have an idea of what to expect. Acetaminophen, ibuprofen and colace are great to have on hand (at home) for any type of delivery. Also, ask if it’s possible to have a clear drape during your section so you can see the baby being delivered- they should be able to do this for either a planned or unplanned c-section (*family centered cesarean tips are included in Strong as a Mother's Childbirth Preparation Class options).
6. Any postpartum/recovery advice or tips for cesarean birth moms?
Even with a vaginal delivery, if you have a multi-level home I would advise feeding/changing stations on each floor to limit having to go up and down stairs. Most hospitals have standing orders for non-narcotic pain medications, so definitely don't skip any of those doses as they can help you stay ahead of the pain. I was really nervous about taking anything extra for pain but I realized being able to move around and take care of my baby was an important part of my recovery as well. I believe a small amount of pain is important for your to recognize your limits with your recovery, but you also don’t want to be fighting through pain to take care of your new baby. Make sure you work with your hospital care providers to manage your pain well.
Thank you so much for taking the time today to read this blog. I hope this post helped clarify or open your eyes to the many reasons why cesarean birth is performed, some benefits, risks, and perhaps taught you about VBAC which you may or may not have been familiar with. I'd also like to sincerely thank Kristin for taking the time to share with my readers her cesarean birth experience and offer up some insider's tips and point of view as both a mother and as a labor nurse. See sources below for further information, and don't hesitate to reach out to me at lauren@strongasmother.net if I can be of further assistance to you as you plan for your upcoming birth and postpartum experience.
SOURCES:
Berghella, V. (2021, January 5). Patient education: C-section (cesarean delivery) (Beyond the Basics). Up To Date. Retrieved April 23, 2021, from https://www.uptodate.com/contents/c-section-cesarean-delivery-beyond-the-basics?_escaped_fragment_=#:~:text=Advantages%20of%20planned%20cesarean%20%E2%80%94%20The%20advantages%20of,risks%20to%20the%20mother%20and%20baby%20from%20labor.
C-section - Mayo Clinic. (2021). Mayo Clinic . Retrieved April 23, 2021, from https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
Cesarean Birth | ACOG. (2018, May). The American College of Obstetricians and Gynecologists. Retrieved April 23, 2021, from https://www.acog.org/womens-health/faqs/cesarean-birth
Cesarean Surgery. Lamaze International. Retrieved April 23, 2021, from https://www.lamaze.org/c-section
Dekker, R. (2020, January 28). EBB 113 - The Evidence on VBAC - Evidence Based Birth®. Evidence Based Birth. Retrieved April 23, 2021, from https://evidencebasedbirth.com/ebb-113-the-evidence-on-vbac/
VBAC: Know the pros and cons - Mayo Clinic. Mayo Clinic . Retrieved April 23, 2021, from https://www.mayoclinic.org/tests-procedures/vbac/in-depth/vbac/art-20044869
Vaginal Birth After Cesarean: VBAC: | American Pregnancy .. (2019, April 25). American Pregnancy Association. Retrieved April 23, 2021, from https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/vaginal-birth-after-cesarean-669/