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| Cesarean Births | |
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During 2009, as many as one third of all women in the US who birth babies will do so by cesarean birth. While this is not the case in all geographic locations, the statistics are staggering. What are the reasons for cesareans? How does the birth differ from vaginal birth? And why is there so much concern? Reasons for Cesarean Birth The reasons for cesarean birth vary with the individual. The old phrase "Once a cesarean, always a cesarean" was true many years ago when the incision made on the uterine muscle was always vertical or made across the muscle fibers. Now, the horizontal incision significantly decreases the risk of uterine rupture (less than 1%) and increases a woman's chance of having a successful TOLAC (trial of labor after cesarean) which leads to a VBAC (vaginal birth after cesarean). CPD or cephalopelvic disproportion: cephalo means head, pelvic means pelvis and disproportion indicates an inability for the head of the fetus to pass through the pelvic bones. Perhaps the baby is quite large and the mother's pelvis is normal for her stature. Or perhaps the baby is "normal" size and the mother's pelvis is small or misshapen. Dystocia or abnormal progress of labor is the second most common indication for cesarean birth. It accounts for nearly 30% of all cesareans. This label may be used after a "failed induction," where the mother has been given cervical ripening agents or pitocin for induction or augmentation of labor. The result is a slowed or stopped labor with no progress in site. Maternal indications such as heart disease, severe pre-eclampsia, insulin-dependent diabetes, active herpes, or obstruction of the birth canal by fibroids. Uterine rupture may also be an indication of cesarean birth and can occur whether the mother has had a previous cesarean or not. Fetal indications such as prolapsed cord, severe uteroplacental insufficiency, malpresentations (transverse, brow or breech), or multiple gestation where the presenting twin is breech transverse. Not all breeches are delivered by cesarean. Some physicians are comfortable with delivering vaginal breeches and some are well versed in "external version." External version involves manipulating the baby from the outside from a breech to a head-down position. Many breech babies have been successfully turned by external version. Placental considerations such as placenta previa (the placenta partially or completely covers the opening of the cervix) or abruptio placenta (a portion of the placenta becomes detached from the wall of the uterus; symptoms may be an obvious hemorrhage or a concealed hemorrhage). How does the birth differ from a vaginal birth? Cesareans are performed much the same in all birthing facilities with only a few variations in procedures. If you are planning cesarean birth, it is wise to tour the birthing facility and find out what the exact procedure is before the surgery. If your birth is an emergency cesarean, some of the procedure may be different to account for the needed speed of delivery. You may even want a doula present to help you through the questions and the emotions that go along with a cesarean birth. Before the surgery, the nurse may obtain a 20-30 minute reading of fetal heart rate using an external fetal heart monitor, give a medication (such as sodium bicitrate) to soothe stomach juices, shave your abdomen, insert a catheter in the bladder, and assist with transportation to the operating room. In the operating room, the mother will be on a table with a hip wedge in place, tilting the body to the left. The anesthesia is given and about 15 minutes later, the baby is born. The next 20 minutes or so include time for the physician to assist in removal of the placenta, close the incision made and place an abdominal dressing over the stitches or staples. The mother and newborn may then be taken to the post-anesthesia care unit (PACU) or the maternity surgical recovery area. Often, newborns are taken to the nursery or intensive care nursery, depending on the status of the mother and the newborn. After the birth, the nursing staff will assess the mother's physical well-being at regular intervals for the first several hours. Pain and comfort will also be evaluated. Feelings of failure, anxiety, feeling overwhelmed, disappointment and confusion are all normal. Women and their supportive family and friends often feel overwhelmed by unplanned or emergency cesareans and exhibit anger or depression when speaking about "missing out" on a vaginal birth. While their heads know that the ultimate goal is a happy and healthy mother and baby diad, their hearts yearn for the physical feeling of the baby slipping down the birth canal. These feelings combined with the physical discomforts of major abdominal surgery may interfere with mothering and bonding with the baby. Going home after just 48 or 72 hours may be stressful to some new families. Supportive family members or doulas who do postpartum work (Postpartum Doulas) are always helpful to the family who has experienced a cesarean birth. Hospitals and some states are instituting maternity home care programs where nurses are sent to the homes within 48 hours of discharge to physically assess the mother and the newborn, answering questions and doing in-home teaching. The doctor may have prescribed medications for pain and placed certain physical restrictions on the new mothers such as not lifting objects heavier than the baby or driving for the first several weeks. Why is there so much concern about the rising cesarean rate? Some researchers are concerned with the rising rate of inductions, that is, the rising rate of beginning labor before Mother Nature starts labor. When labor is begun before the body is ready, the body may not respond to the medications given to begin labor. If the amniotic sack has been broken for a long period of time and there are no contractions, it may then be safer to deliver the baby by cesarean. More research is being done to discover why there are so many inductions, why so many inductions fail and why failed inductions lead to cesarean sections. References: Lowdermilk, D., and Perry, S. Maternity & Women's Health Care. Mosby/Elsevier: St. Louis, Missouri. 9th Edition, 2007. |
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