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Let's talk about Cesareans

Posted on April 17, 2012 at 8:33 AM

In honor of Cesarean Awareness Month, I am going to devote the next two Tuesday posts with some information on cesareans.  I am not going to write a lot on how to avoid one in the first place or the specifics of a Vaginal Birth After Cesarean (“VBAC”) since there is already a wealth of information at the International Cesarean Awareness Network (“ICAN”) and Childbirth Connection websites. Instead I will offer an introduction to the topic for people who are not aware that cesareans are performed at an alarming high rate, and offer a quick look at causes and precautions.  At the end of the post you will find several links for more detailed information.
Here is a brief introduction:
In this country, the cesarean rate in 2009 was 32.9%.  It means that over 1.4 million women and families welcomed their children into the world via a surgical procedure.  It marked the 13 consecutive year of a rise in cesarean rates in the United States.  For a look at cesarean rates by the numbers, click here.
The good news is that for the first time in 14 years, the preliminary data in the statistical year 2010 shows that the cesarean rate went down by 0.1% (from 32.9% to 32.8% - still means over 1.3 million cesareans).  It doesn’t sound like very much, yet by the numbers, that means approximately 405,700 more women had vaginal births instead of a surgical procedure to birth their babies.  There are lots of different factors that contributed to the decline; my Pollyanna is hopeful that all the good work of ICAN, and other educators, is providing information to help mothers avoid what is termed the “unnecesarean”.  For those moms in whom a true emergency situation warrants a cesarean birth, I continue to be grateful for the medical knowledge that allows for a Healthy Mom, Healthy Baby outcome.
The World Health Organization recommends that the cesarean rate should be around 15% (See Reference 1 below).  This is what it estimates to be the more accurate percentage of instances when performing an operation instead of allowing for a vaginal birth saves a mother and/or child’s life.
So are all the cesareans performed in the United States life saving?  Here is a look at how we rank internationally: the "World Health Statistics 2010 identified 33 countries with lower maternity mortality ratios than the United States, while 37 countries had lower neonatal mortality rates, 40 had lower infant mortality rates...” (2)
So working strictly off the numbers, our predominantly medically managed and intervention based hospital model (which includes a high incidence of cesareans) does not equate to a better outcome for mothers and babies.  It is quite shocking to realize that some third-world countries have much better outcomes with their approach to labor and birth in comparison to ours.
Dr. Berman, who sits on the board of the American Academy of Husband-Coached Childbirth®, taught me a healthy respect for what a cesarean really is as opposed to how it is perceived in today’s society.  We had the privilege of hearing him speak at our Bradley Method® training in Anaheim.  According to him, if you were to sustain the injuries and the trauma associated with a cesarean surgery outside of the operating room, you would have a fatal injury that very few people could survive.  Cesareans are a surgical procedure and carry all the risks associated with surgery (see link list below).
Causes and Precautions:
Here are six leading causes of cesareans identified by The Academy of Husband-Coached Childbirth®,
  • Inability to relax
  • CPD: Cephalo-Pelvic-Disproportion ~ the baby’s head is too big to fit through the mother’s pelvis
  • FTP: Failure To Progress ~ the mother’s dilation doesn’t match the care provider and/or hospitals expectations, protocol or practice
  • Fetal distress
  • Prolonged labor
  • Pain
How do you prepare yourself and avoid facing these in your labor?

Inability to relax: attend a childbirth preparation class, like The Bradley Method® series, that teaches you about the process of labor so that you are educated.  Knowledge eases fear and has the potential to break the Fear-Tension-Pain cycle that stops relaxation.  The Bradley Method® also prepares couples with twelve different relaxation techniques – if a couple attends classes and does their homework, they will have several tools to use until they find the one that best relaxes the mother and allows her body to work with her labor.
CPD:  True CPD is a real medical complication.  It is usually found when a woman has experienced severe malnutrition.  However, it cannot be accurately diagnosed until a mother has had a trial of labor, which has a very ambiguous definition (3).  Know how long your care provider will let you labor before coming to this conclusion. 
In addition, we need to remember and trust that our pelvis is a comprised of moving parts, and that there are hormones made by our bodies that relax the tendons so that those parts can stretch and mold with our babies, and then return back to the proper alignment and shape after we give birth.  We also need to remember that labor works best with gravity.  If a mother has been lying on her back and fighting gravity, she will be more tired and her body will be less likely to function as it was designed to do.
If you hear this term in relation to your labor, ask for the time (as long as mom and baby are not at risk) to try different positions and see what your body is capable of.   Chances are good of a vaginal birth if you get a mother off of her back and into positions that open the pelvis and work with gravity, i.e. walking, upright and squatting positions.  With these, her pelvis will be more likely to open and expand to welcome her child vaginally.
I recently learned that a possible indicator for CPD might also be a swollen cervix.  You can read a conversation between midwives here .  I thank my lucky stars that I am not a medical professional when I read their dialogue.  I am always open to sharing information – so please take the time to read this so you can consider possible options you want to ask for if you face CPD in your labor.
FTP: This is a clear instance where knowing what your care provider and birthplace consider “normal” is of utmost importance.  If one or both of them expect all moms to deliver by a certain timeline, find another care provider or birthplace.  All bodies are unique and all babies are unique.  Each labor will be exactly as long as it needs to be – and if you are expected to fit into a particular timeframe or else face the knife, trust your instinct that is telling you that this is an unrealistic expectation.
Fetal Distress:  This is another situation that could be a real medical complication.  Fetal monitors were designed to be used intermittently, and specifically in instances when distress was suspected.  Instead, monitors are used as a continuous procedure unless you make a specific request in your birth plan to have it otherwise.
The word “labor” applies to both the mother and the baby – and as we all know, hard work causes stress.  Most babies will handle the stress of labor beautifully when the mom has stayed low-risk and eaten a well-balanced diet throughout her pregnancy. It is important to read and educate yourself on what true fetal distress is and what the causes are so you can make an informed decision if you start to hear that term during your labor.
If fetal distress is indicated solely due to the tape the machine is spitting out, the first thing to do is ask if you have time.  If the clear and urgent answer is no, then you decide what you want to do for a Healthy Mom, Healthy Baby outcome.  If there is time, then you can ask for a second opinion, and/or ask for them to listen to the baby by other means, such as a fetoscope or a Doppler.  The monitors can give false readings by the simple fact that they are just a machine interpreting the signs from the baby instead of a trained set of hands and a human ear that feels and listens to the baby.
Prolonged Labor: This is a situation when knowing what your care provider or birthplace considers “prolonged”, and also when having a supportive coach and a support team makes a huge difference.  The mother and coaches attitude about having a prolonged labor will affect how a choice for or against a cesarean.  The questions to consider here are: Is the mother okay? Is the baby okay? Do we believe that our labor is what our baby needs?  Are we willing to give baby the time he or she needs to be born? What else could we do/try before we agree to a cesarean?
Every couple will make their own choice under these circumstances.  Their list of things to do or try before they accept a cesarean will depend on their training and the experience of coach or any assistant coaches the couple has with them.  If the mom and baby are not in distress after a prolonged labor, there is no right or wrong answer in this case – it is entirely up to the parents to decide which path they want to choose.  If either the mom or baby is showing signs of distress, the path forward is clearer when you are central goals are a Healthy Mom, Healthy Baby outcome.
Pain: I would be lying to you if I told you that childbirth is painless.  However, the pain is bearable and welcomed when you focus on the result of the work you are doing and when you are surrounded by the love and care of your coach and any assistant coaches.  There are times when the pain changes, and an excruciating pain that doesn’t break and/or that is accompanied by bright red blood and/or large blood clots is a true complication. It could be a life-threatening complication like placental abruption or a uterine rupture.  These clearly indicate a cesarean to attempt to save the life of the mother and the child.
If the pain increases in intensity, but it continues to ebb and flow with the strength of the contractions, then the team needs to evaluate if maybe the baby is malpositioned and needs to be encouraged to move again.  The other cause of intense yet manageable pain could indicate an emotional component of labor that the mom needs to address before labor can resume its normal course.
The bottom line is that you, as a consumer of medical services, need to educate yourself, ask questions of your care provider, and advocate for the choices you want.  If your requests are reasonable, chances are high that you will be able to find a care provider who supports your choices and only uses cesarean surgery in the emergency situations for which it was intended.
ANNOUNCEMENT FROM ICAN: ICAN of Phoenix will be offering a Cesarean Prevention Class on Saturday May 19th from 2-4pm. Location is TBA but will be in the East Valley this time. Cost will be $25 per couple, your other half is strongly encouraged to attend (your doula may attend too, no cost for bringing her). There will be a sign up form on the website as soon as the location is set, but you may rsvp if you already know you will attend. If you need more details please email Stephanie Stanley at [email protected] 
Link List
Things you can do to avoid an unnecessary cesarean:
Risks associated with cesarean:
More information on cesareans and related topics:
ICAN Facebook page:
ICAN Phoenix Facebook page
(1)  World Health Organization. Appropriate technology for birth. Lancet 1985; 2: 436-7.
I used the provisional 2010 number and multiplied it by 0.01%
For the number geeks:
Number of births in the US
Preliminary Data (11/17/11) 2010 was 4,000,279

Feb 2012 update: 4,057,000 for the 12-month period ending June 2010  4,057,000 - 32.8% = 1,330,696 cesareans

Final 2009 Data (11/03/11): Number of births: 4,130,665
4,130,665 – 32.9% = 1,358,989 cesareans
Comparing 2010 to 2009 
2010 Birth rate: 2% lower
2010 Cesarean rate: 0.1% lower
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale

Categories: Birth plans, Cephalo-Pelvic Disproportion, Cesarean Birth, Cesarean Surgery, CPD, Failure to Progress, Fetal Distress, FTP, Information Center, Pain, Prolonged Labor, The Bradley Method®

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