Cesarean Delivery
Avoidable or Necessary?
| Reasons for Cesarean Delivery Due to Health Risks • Previous Cesarean birth with a classical incision • Ineffective contractions with failure to progress into labor • Very premature infant • Maternal cardiac condition • Uncontrolled diabetes • High blood pressure • Pregnancy-induced hypertension • Prolonged rupture of membranes beyond 24 hours • Multiples (twins, triplets, etc.) • Active case of genital herpes If these conditions DO NOT exist, there are steps that you can take to prevent birth by Cesarean delivery. |
Although you may not want to think about it, your birth may not proceed as expected. Complications may arise that will require that you make important decisions regarding the birth of your child such as whether to proceed with a Cesarean birth. Be prepared and review your options prior to delivery!
What is Cesarean Delivery?
When the baby has to be surgically removed from the mother, the procedure
is called birth by Cesarean Delivery. As with any medical procedure, Cesarean
delivery involves a degree of risk & recovery and is performed if
the health and welfare of the mother and infant are jeopardized.
Indications for Cesarean Birth
Cephalopelvic Disproportion (CPD) - The baby’s head is too big to fit through the mother’s pelvis.
Fetal Distress - The baby cannot tolerate the forces of labor or intrauterine environment.
Abnormal Presentations - The position of the baby prevents safe passage through the pelvis and birth canal.
Breech Presentations - The bottom or feet are the presenting part of the baby.
Placenta Previa - The placenta is positioned over the opening of the uterus.
Abruptio Placentae - The placenta prematurely separates from the uterine wall.
Cord Compression - The cord is pinched or has fallen between the baby and the pelvis.
Maternal Complications - Any serious medical condition that jeopardizes the mother and baby.
How Can You Avoid Cesarean Delivery?
Begin by asking caregivers about their rates of Cesarean birth. Ideally,
they should be no higher than 15% - 25%. At your initial visit, share
with your caregiver that your goal is to avoid Cesarean birth unless absolutely
necessary. Several times during your prenatal visits, remind your caregiver
of your initial goal. If you are in a multi-physician practice, ask that
a notation be made on your chart that will inform any caregiver who may
be delivering your baby. About three weeks before the due date, ask the
caregiver to assess the position of the baby. If the baby is not in a
head-down position, ask the caregiver if the baby can be turned. Medically
this procedure is called an “external version”.
With your caregiver or childbirth instructor, explore exercises that you can do to help rotate the baby. With your labor support person, practice relaxation techniques often. Gather as much information as you can about the birth process and what to expect during labor. The more knowledge you have, the less anxious you will be about the normal process of birth.
Think about the different things that help you feel relaxed. Make a list and obtain items to take with you in labor. Turn your labor room into a safe haven by surrounding yourself with the items that you associate with relaxation. Posters, scented body lotion, extra pillows, music, pictures of past vacations or loved ones can be placed in view and used as tool to enhance relaxation and concentration. Share your goal of vaginal delivery with any other medical support person as their support can mean the difference.
While in labor, avoid lying on your back. The pregnant uterus exerts about forty pounds of pressure, which can interfere with blood flow to the uterus and the baby. Generally, when a laboring mother is laying on her back, the contractions are further apart, less effective, and more uncomfortable. Alternatives to the laying position include walking, rocking, standing, kneeling, squatting, and kneeling on hands and knees.
Always try to take advantage of the time between contractions to rest. Use your relaxation techniques to decrease tension. Effective ways to reduce pain include massage, counter pressure, hot and cold water compresses, positioning, imagery, music, warm showers, hot tubs, and medications. IF you do have to remain in bed, raise the head of the bed by 20 degrees. Change your position every 15 minutes. Move from side to side. Sit with your legs crossed. Rock gently backwards and forwards while on your hands and knees.
If possible, avoid the use of epidural anesthesia. Epidural anesthesia can slow down labor. Because of the numbing sensation caused by the epidural, you will be unable to walk (which uses gravity to help labor progress). If the epidural slows labor, the doctor may use the drug Pitocin to promote contractions. Pitocin enhances the strength and length of the contractions, which can lead to a deceleration in the baby’s heart rate. This slowing of the heart rate may prompt the physician to perform Cesarean birth. With the epidural, many women cannot feel to push effectively, thus prolonging labor, which can also lead to Cesarean birth.
If the fetal monitoring indicates fetal distress, request that the physician assess the baby’s oxygen level via a scalp test or fetal acoustic stimulation test. The actual oxygen level of the infant is a more accurate way to determine if the baby is in danger.
Make a list of the alternative tools that you can employ during labor. In the months prior to delivery, frequently practice these measures with your coach. Early in labor, share your list with your doctor and nurse. Working together as a team, you, your coach, doctor, and nurse can take active steps to attain your goal of avoiding Cesarean delivery.