A Dozen Days of Doula Scoop: Day 9

C-sections: Having a good birth when a cesarean is necessary

Cesarean sections save lives. This fact is incontrovertible. Unfortunately, currently about a third of pregnant women in the United States will wind up delivering their baby by cesarean section. This number is far higher than the 10 to 15 percent of moms recommended as the target goal by the World Health Organization. The discrepancy between the target percentage and the actual percentage means that some women are having unnecessary c-sections. The problem is that during labor, no one wants to take chances with the life or health of mother or baby, so if there is any reason to believe a c-section may be a safer means of delivery, it will probably be done. Also, doctors often take every action possible to protect themselves from liability so that if something were to happen to mom or baby during a birth, they could say, "Well, I did everything I could." What this means for you as a mom is that (a) you may want to take measures to protect yourself from an unnecessary cesarean and (b) you need to prepare for a cesarean birth even if you are planning a natural childbirth because you end up needing one during labor. Here is an excellent page that covers ways to avoid an unnecessary c-section. I highly recommend you check it out so you can arm yourself with information.

When a c-section is truly necessary, there is no agonized weighing of risks and benefits. There are a few situations where there is no question of whether a c-section should be done:

• Cord prolapse, placental abruption, catastrophic uterine rupture: These are all true obstetrical emergencies that require immediate action to save the baby and sometimes the mother as well.
• Placenta previa: This is the term used when the placenta embeds itself over the mouth of the uterus where the baby would usually emerge during birth. Because the placenta is the baby's oxygen lifeline, he could not be born vaginally because the process of the cervix dilating almost always causes the placenta to begin detaching from the blood supply.
• Baby is in a transverse position and refuses to move: Transverse means the baby is lying sideways in the uterus in much the same position that moms cradle their babies after they have been born. Babies in a transverse position cannot be delivered vaginally. The good news is that about 90 percent of transverse babies can be turned using a procedure called the external cephalic version.

The link above covers most of the situations where it may be possible to avoid a c-section: breech baby, long labor (slow progress), previous c-section, questionable fetal heart rate readings, and multiple births. If you find yourself in one of these categories before labor begins, research! Read The Thinking Woman's Guide to a Better Birth. Ask your doula for other resources. Ask your care provider how he or she usually handles your situation. If you are not happy with the answer, negotiate a better plan. If you find your doctor is inflexible, consider changing to a care provider who is more in line with what you want, even in the last weeks of your pregnancy. If you face one of these problems during labor, use the four questions I discussed in yesterday's post. Ask your doula for information. Talk through the situation with your husband. If you feel like the c-section is needed, give your consent and know that you are doing the right thing for your baby.

If you choose to have a doula at your birth, ask your doctor before labor starts if they allow both dad and doula into the operating room during a c-section. The official hospital policy usually allows one additional person (either dad, doula, or another labor support person), but doctors often have the final say on whether your doula will be allowed in the O.R. along with dad. It's worth making the effort to have your doula with you during the surgery because it is often a tense and emotional time when a calming influence is greatly needed. Also, babies are often taken to the nursery after the mom gets a quick look at them so the nurses can evaluate and monitor their condition. If baby goes to the nursery, it's best for dad to go with her since as her legal guardian, he is the person with the power to make decisions related to the baby's care. However, if he was the only support person with mom in the O.R, she is then left alone during the lengthy surgical repair. When dad and doula are allowed in the O.R, it allows for the most complete level of emotional support for mother and father throughout the process of the cesarean birth. If this is not possible for some reason, your doula will wait for you to return to your room for some recovery time after the surgery, and help you hold and feed your baby if you are both up to it.

Having a c-section is not a failure of the mom to give birth. After all, you grew and carried that baby for nine months, and your baby entered the world from your body, albeit in a departure from the normal pattern of birth. Stuff happens. Life happens. Cesarean birth often requires a lot of emotional processing. You may need to spend some time grieving for the birth you lost. That's okay. But at the end of the day, you need to know that you allowed your baby to be born in the way that he needed, and that is what a good mommy does.