Understanding C-sections

Read along as we look at some facts about C-sections and talk to some strong mamas about their cesarean and VBAC births…

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Welcoming a baby into the world is a transformative, life-altering experience. Some of us have beautiful birth stories, while others have traumatic ones. Long and arduous labors versus short and sweet ones, unmedicated water births versus cesareans performed in an operating room, home births versus hospital births… the scenarios are as varied as the mothers who experience them.

While most babies are still delivered vaginally, the rate of C-sections in the United States has been steadily increasing since the mid-1990s. In 2016, 31.9 percent of babies were born via cesarean. That’s more than twice the ideal 10 to 15 percent rate of C-sections recommended by the World Health Organization.

A cesarean is a major operation that carries several risks. Most significantly, the probability of maternal death is at least four times higher for C-sections than for vaginal deliveries (with some studies showing the risk to be up to 11 times higher). Other complications can include infection, hemorrhage, damage to the bladder or intestines, and blood clots in the legs or lungs.

To reduce preventable cesareans and advocate for vaginal birth after cesarean (VBAC), the International Cesarean Awareness Network (ICAN) holds Cesarean Awareness Month every April. Let’s look at some facts about cesareans and VBACs.

Why are C-section rates so high?

The assumption that C-section rates in the U.S. are increasing because more and more women are demanding them without any medical justification is a myth – one that’s continuously perpetuated by health professionals and the media. But according to a major survey by nonprofit organization Childbirth Connection, only 1 percent of women who had a primary cesarean (for their first birth) planned it knowing that there was no medical reason for it.

Other reasons that are often cited include the higher proportion of older women with medical complications who are now giving birth and the rising rates of multiple births. But researchers at Boston University analyzed medical records over an 11-year period and found that C-section rates have gone up for all groups of women regardless of age or number of babies.

Even the idea that doctors are pushing cesareans because they fear malpractice liability has been discarded as a major influence – it can only account for a small proportion of the increase.

So, why are C-sections so popular? Childbirth Connection points to a complex web of reasons: medical professionals don’t empower women to believe in their own ability to give birth, many common labor interventions make C-sections more likely, doctors are less willing to perform vaginal births because they take longer and are less lucrative, our society now has a casual attitude toward surgery, and the list goes on.

“My OB/GYN told me I should have a C-section because my baby was measuring big and his shoulders could get stuck during the birth or there could be other complications,” says Milwaukee mom Beth. “I just blindly trusted him because it was my first pregnancy. But when my son Jackson was born, he was only 8 pounds rather than the 10 pounds the ultrasound had said! I was really upset that I was pushed to have an operation for no reason, but my OB just shrugged it off, saying that ultrasounds can be wrong.”

Despite unfortunate stories like Beth’s, there are plenty of cases in which C-sections are medically necessary for the health and safety of the mom or the baby – or both. And for other women, past traumatic births or other psychological or physical reasons may rule out a vaginal birth. So while reducing the C-section rate is a noble goal, we should be careful not to alienate brave C-section mamas in the process.

“I stopped going to my mothers’ group because I felt so judged by them for having a C-section,” says Detroit mom Hailey. “They’d almost all had natural births and they were extremely judgey about anyone who hadn’t. I tried to explain that my doctor had recommended it because my daughter was breech, but they made these backhanded comments about how you can give birth to breech babies naturally! As soon as I left the group, I started to feel better about myself. I’m not ashamed I had a C-section – I did what I had to do to get my baby out safely and I wear my battle scar proudly.”

What can I do if I don’t want a C-section?

If this is your first baby, make sure to interview several healthcare providers before settling on the one who will deliver your baby. OB/GYNs and family physicians are more likely to use labor interventions and perform cesareans, whereas midwives offer a more natural and individualized approach to childbirth with little medical intervention.

During the interviews, ask each provider about their birthing philosophy, their rates of vaginal births versus C-sections, and whether they’ll support your wishes for a natural birth. If you don’t feel entirely comfortable with their answers, keep looking until you find the right provider for you.

But if you’ve had a cesarean in the past and you’re keen to attempt a VBAC, you might have to shop around a bit more. Many doctors refuse to perform VBACs due to malpractice insurance concerns and many hospitals don’t allow them, so your first step is to find a VBAC-friendly doctor – preferably one that has at least a 75 percent VBAC success rate and a lower rate of cesareans than the community average.

You can call your local hospital to enquire about their VBAC policy and ask for the names of VBAC-friendly doctors or head to ICAN’s website to find a chapter near you where you can attend a meeting and ask for recommendations. Once you’ve found a doctor you trust, they’ll evaluate you and decide whether you’re a good candidate for a VBAC.

VBACs are successful 60 to 80 percent of the time. There’s always a chance you’ll have to have an emergency cesarean after laboring, but for many moms that’s a risk worth taking.

“I was traumatized after the birth of my first daughter,” says Tallahassee mama Karen. “I had to have an emergency C-section because she was in distress. Then I had a reaction to the anesthesia and I almost didn’t make it. It was awful. It took me five years to get up the nerve to get pregnant again. When I finally did, I was adamant I’d have a scheduled C-section. But my doctor was amazing – she gently suggested that I was a good candidate for a VBAC if I was up for it. I was hesitant at first, but I hired a doula who helped me build confidence in myself and my capacity to give birth naturally. And I did it! It was the best experience of my life.”