So often, when we are preparing for a natural birth, we forget to look at the “what if’s”. For most moms, the thought of a c-section is utterly terrifying so it’s good, no great to hear that there are other options. As much as we plan for and expect the best, there are a few medically indicated reasons for a c-section and the fact is, c-sections can save lives. Unfortunately, here in the us that procedure is grossly overused! “The World Health Organization recommends that the cesarean section rate should not be higher than 10% to 15%.” (1) Right now the CDC is reporting that in the US 32.8% of all birth are via cesarean section. (2) ACOG (the America College of Obstetrics and Gynecology) had released their medically indicated reasons (3):
* Complete placenta previa at term
* Transverse lie at complete dilation
* Prolapsed cord
* Abrupted placenta
* Eclampsia or HELLP with failed induction of labor
* Large uterine tumor that blocks the cervix at complete dilation (Most fibroids will move upwards as the cervix opens, moving it out of baby’s path.)
* True fetal distress confirmed with a fetal scalp sampling or biophysical profile
* True absolute cephalopelvic disproportion or CPD (baby too large for pelvis). This is extremely rare and only associated with a pelvic deformity (or an incorrectly healed pelvic break). Fetal positioning during labour and maternal positioning during second stage, most notably when women are in a semi-sitting position, cause most CPD diagnosed in current obstetrics.5
* Initial outbreak of active herpes at the onset of labor
* Uterine rupture
ACOG also “advocated delaying deliveries until 39 completed weeks of gestation or beyond” but I digress… When Medically indicated, a c-section can be the best option for mom and baby so why then are we making this such a scary thing for our moms and babies. Here in Atlanta, we are very fortunate to have a doctor (Dr Bootstaylor at SeeBaby and the amazing midwifes at Intown Midwifery) that supports Family Centered Cesareans which really keeps the family involved in their birth. Here are some of the differences between a traditional and a family centered cesarean.
| Family Centered Cesareans | Traditional Cesareans |
| – mom hands are free | – moms are are strapped to the table |
| – both parents are included in the birth, partner and baby stay with mom in the OR | – partner (or just baby) go to recovery while mom stays in the OR |
| – baby is delivered slowly to allow the fluid to be squeezed out of the lungs | – baby is delivered very quickly |
| – as the baby in being born, the surgical drape is dropped to allow the parents to see the birth | – the surgical drape is obscuring most of moms vision |
| – babies cord is clamped after it has stopped pulsing | – babyes cord is clamped and cup immedialty |
| – the baby is brought to moms chect to do skin-to-skin | – baby is taken immediately to the warmer for assessment |
| – the lights are lowered to allow family bonding while the surgery is finished | – mom is usually left alone in the room while baby and partner go to recovery |
While these may seem like small changes, they make a huge difference to the new family without sacrificing safety. So now what??? When you are pregnant, talk to your care provider about family centered cesareans to see if that is something they support and routinely practice. If they do not, you can either switch providers or educate them . You never know, you may be the one to change their mind!
1. http://www.who.int/bulletin/volumes/85/10/06-039289/en/
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