EP 19//Paradigm Shift: Emergency C-Section or Was It?
Updated: Apr 27, 2020
Cathy was pregnant with her first. She chose her doctor based off of a friend’s recommendation. She had an uneventful labor up until 9cm where her baby started showing some signs of distress and a c-section was performed. She was thankful that her baby was safe but something told her that there was something else that could have been done and it wasn’t as much of an emergency as her doctor made it seem.
The current rate of c-sections in America is 32%. They have become widely accepted as a “normal” means of delivery. Moms now share stories of their traumatic delivery turned emergency c-section and are thankful that the doctor saved them and their baby’s life. But is that the reality?
“But only about 5 percent of C-sections are true emergencies, estimates George Macones, M.D., chairman of the department of obstetrics and gynecology at the Washington University in St. Louis School of Medicine, in Missouri. Around 3 percent are completely elective, meaning there's no medical reason whatsoever, but the vast majority of C-sections actually fall into a gray zone: the baby looks big, mom is past her due date, labor isn't progressing well.” http://www.cnn.com/2009/HEALTH/11/11/caesarean.section.risks/
The World Health Organization (WHO) released a statement about cesarean rates in 2015. WHO completed a systematic review to find the ideal c-section rate and they said this about their findings:
“At population level, caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates.”
Before you are able to determine if your c-section was an emergency, urgent, or neither, we need to discuss some classifications:
Emergency - Immediately life-threatening to woman or fetus
Urgent - Maternal or fetal compromise that is not immediately life-threatening
Scheduled - Needing early delivery but no maternal or fetal compromise
Elective - At a time that suits mother and maternity team
You can use the classifications above along with the following information to help you determine if your c-section was truly an emergency, or if it was instead urgent:
In an emergency, time is of the essence. In a typical emergency, baby can be out from the time of incision to delivery in a couple minutes! If you haven’t previously had an epidural, general anesthesia is needed.
In an urgent situation, the doctor can take up to 30-60 minutes to start the surgery as there is time to be more careful with the incision.
One last tip is to find out the reason for your c-section. You can do this by requesting records from your hospital.
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C-sections are overused. They are no longer seen as a major abdominal surgery that should be reserved for true medical emergencies, but instead convenience and liability are the winning factors in deciding if a mother will have a c-section. And yet, c-sections are inherently more dangerous than a vaginal birth. The statistics speak for themselves.
Check out the graph from the ACOG :
Tips for first time moms to avoid a c-section:
Find a provider with a low c-section rate. Interview a few if you have to. Call the office and ask the nurses who the best provider is for a vaginal delivery. Do your research!
Hire a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery.
Choose a location with low rates. Hospitals have their own c-section rates that are based off of policies and the culture. ICAN has stats on hospital rates. Homebirth and birth center locations should be considered as an option, especially for low-risk women.
Avoid interventions. There are so many different factors that go into a primary c-section, but avoiding induction is the first step. Cascade of Interventions usually starts with an induction and often leads to a c-section.
Research your options. When you know better, you do better. You can’t always be in control of what happens during your birth, but you can be in control of your thoughts and actions. This starts with being knowledgeable about the physiological process of birth. You can do this by taking an in-person birth class, or one online such as The Empowered Mama’s Birth Guide
When the primary rate of c-section is reduced, it will in turn reduce the repeat c-section rate. First time moms… you are the change!
Let me tell you about Janelle. She was pregnant with her first. She had heard the stories of traumatic deliveries from other moms and she knew she wanted it to be different. She decided that she was going to do all she could to improve her chances of having a blissful experience. She started researching and found a birthing center near her. She learned what to expect during a physiological labor and started preparing her mind and body for the transformation into motherhood. Because of all the work she did during her pregnancy to reduce fear, build her birth team, learn physiological labor and prepare her body she had a beautiful uninterrupted vaginal labor.
It is possible to have a beautiful vaginal delivery but the current culture makes it difficult. It takes planning and preparation. And to be clear, c-sections are life-saving procedures that are needed in emergency situations. When you know your options and you’re in control of the decisions made during your pregnancy and labor, you can feel confident in knowing that you’ve done everything you can to have a vaginal labor and that the c-section was medically necessary.
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