Common Interventions: Cesarean Sections
There are so many strong opinions about cesarean sections, or c-sections, it can be hard to feel prepared for the possibility of one. Part of working with a doula is preparing for all possible scenarios based on the birth experience you want and the best information available to you. To get you started, check out this overview of c-sections – what they are, when they happen, the risks and benefits, and how you can try to avoid this surgery if that’s your priority.
What is a cesarean section?
A c-section is a surgical procedure to deliver a baby when the baby can’t be delivered vaginally. Instead, the surgeon makes an incision in the mother or pregnant person’s abdomen and uterus.
When are they performed?
About 32 percent of births in the U.S. in 2015 were cesareans, according to the U.S. Centers for Disease control. They may be performed in one of three circumstances:
· Planned c-sections are scheduled in advance when the pregnant person and doctor agree that the surgery is less risky than a vaginal birth. For example, some women schedule a c-section if they already know the baby has a disability that would make vaginal delivery risky. Some reasons for planned cesareans that are still debated in the medical community include if the mother has had a c-section before, if the baby is expected to be large, or if the baby is in a breech position (bottom or feet facing down).
· Unplanned c-sections are scheduled in the case of an unexpected complication during labor. For example, if a laboring person develops a genital herpes outbreak during labor, a c-section can prevent the baby from developing an infection. However, most unplanned cesareans happen due to slow labor, or “Failure to Progress.” This is a controversial reason for a c-section that you should discuss with your doctor ahead of time if you want to avoid it.
· Emergency c-sections are performed if the pregnant person or the baby’s life is in danger. Reasons for emergency c-sections include complications that mean the baby isn’t getting enough oxygen and uterine rupture, or tear in the uterus, in the scar from a previous c-section.
What is the surgery and recovery like?
Some emergency cesareans are done under general anesthesia, meaning you sleep through the whole procedure. But, usually, the anesthesiologist uses an epidural or spinal block to numb the lower half of your body. If you have a partner with you, he or she can stay for the procedure, and you stay awake while your baby comes into the world. But, you don’t have to watch the surgery – the nurses will place a screen below your neck. You might feel pressure and tugging, but no pain.
After the surgery, you’ll stay in the hospital for about three days. You may feel nausea or itchiness because of the medication used during surgery. Recovery takes weeks, and is more involved after a cesarean than a vaginal birth. That’s because you’re recovering not just from birth, but from major abdominal surgery. Parents who had a c-section might especially benefit from the help of a postpartum doula.
What are the risks and benefits?
The risks that a c-section carries include many of the risks of any major surgery:
· Blood clots
· Complications with the anesthesia
· Separation from your baby (although many hospitals work to bring parents and babies together as soon as possible after a cesarean)
· Future pregnancy complications
The benefits depend on why you get a c-section. Emergency cesareans can save your life or your baby’s life. But, when it comes to scheduled c-sections, there’s a lot of debate in the birth community about whether they’re always necessary. This is especially true of c-sections scheduled because the mother has had a c-section in the past, because the baby is thought to be too large, or because labor is progressing slowly. To learn more about the risks and benefits of c-sections in these situations, check out this paper from Lamaze International. [http://www.lamazeinternational.org/p/cm/ld/fid=126]
How can you avoid a c-section?
Some proven ways to reduce your chances of getting a cesarean are:
· Laboring at home for as long as you’re comfortable before going to the hospital
· Finding a doctor and hospital with low cesarean rates
· Having a birth doula
· Avoiding interventions that may slow labor, like an epidural (anesthesia that numbs you below the waist)
· Questioning your doctor if he or she proposes a c-section when you and your baby are not in danger.