C-section

Cesarean surgery provides an opportunity to deliver a baby and save the life of a mom for deliveries that wouldn't have been possible a hundred years ago. Unfortunately this type of delivery has gone from its' original purpose of saving the life of mother and baby, to being used merely out of convenience in some cases, made as the only option for moms who have already had a cesarean, and is being caused by many of the routine medical interventions that I have mentioned in my other blog posts (such as induction and epidural). In 1970 the percent of births that were cesareans in the U.S. was 5.5%. In 1993 it was 22.8%, and in 2006 the rate was 31.1%, which is about where it sits now. This is at least double anywhere else in the world, where their medical skills and opportunity are just as high as our country. So the increased percentage is not due to the fact that they are getting more proficient at the procedure and that is is more available for those who need it.
"At rates above 15%, the risks to mother and baby begin to outweigh the benefits." In other words, really only 15% of women NEED a cesarean - yet here we are in America where the rate is over 30%.

I do not know anyone that has elected for a cesarean, but I know there are still a few women out there that do. Elective cesareans that have no medical reason and are based on convenience/scheduling are completely preposterous and should never happen.
Cesarean being the only option because you have already had one are turning out to be a myth as well. Many, many women have delivered vaginally after a cesarean (VBAC) without any complications - so you should thoroughly research the option for yourself if you have already had a cesarean.
And, finally, a cesarean should be avoided at all costs. How is this done? By avoiding all the medical interventions leading up to it at all costs. Remember all my other posts that state that Pitocin and epidural increase your risk of cesarean, and yes I am using the word "risk", because, quite frankly, cesareans are very risky. They are only worth it if it is an actual emergency and there are no other options. Unfortunately the "emergency" is unnecessarily created by all of the unnecessary medical interventions.
Well, let's get onto to specifically what is at risk to mom through having a cesarean:
-The risk of the mom dying after an elective cesarean is 2 in 10,000, which is 4 times higher than a normal vaginal birth
- Twenty to forty percent of women have post-cesarean complications. Infections of the uterus and urinary tract are the most common.
- Women are twice as likely to have severe complications
- Five times more likely to require antibiotics (remember the effect those have on baby!)
- Up to 1 in 10 women experience an accidental cut elsewhere in the uterus
- Three times more likely to have major infection, hysterectomy, and cardiac arrest
- There is more than a 50% increased risk of having a stroke in the year following cesarean
- Less satisfied with birth experience
- More likely to be re-hospitalized
- Less confident with their babies
- Less likely to breastfeed
- More fatigued (even up to 4 years later)
- NOT better for pelvic floor function (as sometimes thought)
- Reduces fertility: this may be voluntary and involuntary, as 1 in 4 women are still fearful of birth 5 years later

A cesarean does effect any following pregnancies and births as well:
- An ectopic pregnancy is more likely
- It doubles your risk of unexplained stillbirth
- Doubled chance of breech baby
- Increased risk of uterine rupture
- Placental problems increased 2 to 4 times, all of which are life-threatening to mom and baby
- Seven to 15 times the risk of emergency hysterectomy after two cesareans
The risk of most of these complications increase with the number of previous cesareans, but a VBAC is actually just as safe (has the same mortality rate) as a first time birth. And a VBAC is most successful at home - so look into it!

Most importantly, the risks to a healthy baby include:
- Baby is 2 to 5 times more likely to need the NICU (around 10% of cesarean babies are born MORE than two weeks early)
- Breathing difficulties
- Over 4 times more likely to get persistent pulmonary hypertension
- Seventy to 90% more likely to die before hospital discharge (this is of babies who were originally low risk!)
- One to 2% risk of cutting the baby with the knife

Okay, but like I said at the beginning, sometimes cesareans are actually necessary. In other words, due to actual complications, a cesarean provides a higher chance of a successful outcome than a vaginal birth.
These are some GOOD reasons to have a cesarean:
-Severe placental previa
-Placental abruption
-HIV infection
-First time herpes at end of pregnancy
-Severe fetal distress/complications (remember Pitocin/Epidural causes this, so avoid those in the first place at all costs)

These are some BAD reasons to have a cesarean:
-Large baby and/or small pelvis
-More than one week overdue
-Hepatitis B
-Uncomplicated infection with Hepatitis C
-Multiple births
-Small-for-date babies (remember how inaccurate ultrasound readings can be anyway)
-Premature babies
-Recurrence of herpes in mom
-Breech baby: this one is still somewhat debatable, but I do know that my midwife has delivered many breech babies vaginally - at home!

When a cesarean is warranted, here are suggestions as how to have a good cesarean:
*Wait for labor to begin
*Use an epidural or spinal
*Lower the drapes to see the birth
*Clamp cord late or not at all (see last blog post on cord-clamping)
*See or take home placenta
*Immediate skin-to-skin contact with Mom or Dad and continue as much as possible
*Choose a Baby-Friendly Hospital
*Use the lowest dose of painkillers possible following the birth
*Get the two-layer suturing (not one-layer)
*Breastfeed!

So the jist is this: NEVER elect for a cesarean without a GOOD medical cause. Avoid causing the need for a cesarean by not being unnecessarily induced with Pitocin and avoid an epidural at all costs, as both of these increase your chance of cesarean. When a cesarean does have to occur, follow that last list of suggestions. And if you have already had a cesarean and will have another birth, VBAC is definitely an option! And if you really want to increase your chance of avoiding a cesarean, homebirth is your best bet, with only at 3.7% rate of homebirths resulting in cesarean.

As always, I am not claiming to be the know-it-all on childbirth. I am just sharing some of the things I have discovered by educating myself through reading and strongly encourage all of you to do the same.