April is:
In 2010, 32.8%
of babies born in the United States were born via C-Section. That means one in three babies in our country
came into the world on an operating table.
Some states have rates
close to 40%. My current home state of Florida had
a rate of 37.8% in 2010. Some hospitals have rates
over 50%. The
hospital where I delivered my daughter, via cesarean section, had a rate of 33%
in 2010.
Cesarean Sections are an amazing life saving tool,
and have greatly reduced maternal and infant mortality rates. However, it has become commonplace to suggest
that mothers, especially first time mothers, resort to c-sections when it may
not be in her or the baby’s best interest.
Unfortunately, some obstetricians and midwives have resorted to what is
known as “defensive
medicine” – where doctors make treatment decisions based
on CYA (cover your ass) practices instead of providing actual evidence-based
options.
It happened to me.
My daughter was born August 28, 2010. I found out at my 39 week appointment on
August 26 that she was breech (I had
asked a midwife a few weeks earlier about her position and she told me she
thought she was head down – however, she had not moved during those few
weeks. But that experience is a story
for another time). I was given few
options due to how far along I was. I
was told I could try moxibustion
(acupuncture – which I went in for a session the next day), an external
cephalic version (which I scheduled for that Monday,
August 30), or schedule a c-section. I
wanted a c-section to be my last resort, as up until that point, I had been
preparing for a med-free/intervention-free birth. But, my daughter decided for me, as I went
into labor the next night.
This past year, when I was pregnant with my son, I
was talking to the midwife that assisted in delivering my daughter in one of my
prenatal appointments. We were
discussing things that may prevent me from having a successful Vaginal Delivery
After Cesarean (VBAC) (such as breech positioning). I asked if she agreed with the “c-sections
for all breech babies” idea and she told me that it was due to how litigious
our society was that she won’t deliver breech babies. Then, she went on to tell me how she
delivered breech babies all the time when she worked abroad. So, there I was, with a care provider
experienced in delivering breech babies that chose not to use her skills (skills that
are a rarity these days) and allowed me, as a first time mom, to undergo major
surgery when she could have helped prevent it.
Breech
Positioning is just one reason that potentially leads to unnecessary
cesareans. I say potentially, because
there are several different types of breech
presentations, some of which are more
favorable to vaginal delivery than others, and some that
pose greater risks. My daughter was a
mix of complete and frank breech. Other
reasons include:
Unnecessary
Inductions: Just like cesareans, inductions
should be used when there are existing
conditions which could pose a risk to mom or baby if the
pregnancy continues. However, more than 40%
of first-time moms have their labor induced.
When medications are used to force labor, a first-time mom doubles her
chance of having an unplanned C-section.
Remember, the due date is actually “due month” and having a baby
anywhere between 38 weeks and 42 weeks is NORMAL.
Failure
to Progress (Failure to Wait): Labor is not a race. It is work.
Normal labor can last hours, days, or even weeks. Sometimes women are admitted to the hospital
while in early labor (vs. active labor)
and this can lead to what is considered failure to progress. If mom is doing well and baby is doing well,
there is no reason a mother shouldn’t be allowed to labor as long as necessary.
Fetal
Macrosomia (“big baby”): The size of your baby alone
should never be a reason to consider a cesarean, even if attempting a VBAC. Ultrasounds are not an accurate way to
predict the size of your baby in the late 3rd trimester, nor is
there a way to accurately measure your pelvis to determine whether or not the
baby will “fit” down the birth canal. In
fact, ultrasounds
have been shown to be off as much as a full pound (either plus or minus). Also, your physical stature provides no
indication on the size of baby you will be able to deliver. If you are petite, you could still very well
easily deliver an 11lb baby. My
husband’s aunt, who I would consider petite, delivered all four of her
children, all bigger than 9lbs at birth, vaginally.
“Once
a Cesarean, Always a Cesarean”: If you have already
had a previous cesarean, it is no longer “required”
that all subsequent deliveries be via cesarean.
In fact, most women who have had a previous cesarean are candidates for
VBACs and 75% of women who attempt VBACs are successful. I am proud to say that
the birth of my son allowed me to be a part of this positive statistic.
There are many great resources regarding Cesarean
Sections and VBACs. I encourage you to
visit these sites for more in-depth information:
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