Category: Shelley’s Blog

Reasons to Avoid a C-section

There’s lots of information out there about WAYS to avoid a cesarean, but I still have a lot of parents ask me “Why should I WANT to avoid a c-section?” They know many friends and family who have had one, and it seems faster, easier, and more convenient for all. “Why bother risking the process of labor when there’s a chance I’ll need one anyway?” Is there really anything wrong with just scheduling a primary cesarean for no medical reason? Here’s my top 3 reasons to avoid a c-section, if you can:

1.A Cesarean Birth is still major abdominal surgery. Even though many cesareans are done every day and are considered a routine procedure, they still come with a package deal of additional risks in compared to vaginal birth including:

Increased risk of infection and being re-hospitalized due to complications

Increased blood loss for mother

Risk of accidental injury to internal organs

Recovery is longer, usually more complicated, and more painful than vaginal birth

Increased risk associated with anesthesia required for cesarean birth including respiratory problems or allergic

reaction.

2. There are risks to your Baby. While some babies need to be delivered by cesarean, a healthy, low risk baby is better off traveling through the “traditional” route for various reasons.

Risk of accidental injury to baby during delivery

Increased breathing problems and need for medical intervention

Increased rate of babies being sent to the NICU

Delayed mother-baby interaction and breastfeeding

3. A Cesarean increases the risk with future pregnancies. With each subsequent pregnancy, we tend to see:

Increased problems getting pregnant again

Increased rates of miscarriage,  ectopic pregnancy and stillbirth

Increased risk of placental problems due to surgical scar tissue on the uterus (adhesions)

Increased risk you’ll need another cesarean, which starts the circle again.

I’m certainly not saying all women should avoid a cesarean. There are plenty of cesareans that save lives of mothers and babies. All women should become empowered consumers and have open communication with their caregivers about their personal situation and make choices that are right for them. For more information about Cesareans, see the Childbirth Connection website “What Every Pregnant Woman Should Know about Cesarean Birth” http://www.childbirthconnection.org/article.asp?ck=10164

Great news for birthing families in Austin– St Davids Medical Center (32nd street location) has received their Certificate of Intent from Baby Friendly USA. This is the first step in  becoming a Baby Friendly hospital– currently there are no Austin area hospitals that are officially Baby Friendly. What does this mean? They abide by the UNICEF 10 Steps to Successful Breastfeeding. For more information http://www.babyfriendlyusa.org/eng/index.html

What should I consider when creating a Birth Preference Plan?

A traditional Birth Plan used to be a rigid document, stating distinct preferences, often indicating a lack of flexibility. Modern Birth Preference Plans can state your preferences while still remaining flexible, and indicate that you are open to hearing of suggestions or alternatives that might stray from your original ideas.  Your goal should to be to convey your preferences to your caregivers so they can understand how to best support you during labor and birth.

Who will support you during labor and birth? (husband, doula, friend, mother)

How do you feel about induction and/or augmentation?

Fluids by mouth or IV? Is a Saline Lock (also known as Hep lock) an option for you?

Intermittent or Continuous monitoring? Are there wireless (radio transmitted) monitors available?

Do you want to move around, walk, shower during labor? How to you want the room set up? (Lights, music, quiet voices, etc.)

What are your plans/how do you feel about pain medications? What if labor was longer or more difficult than you anticipated? How would you like the staff to handle offering pain meds?

What are your preferences for pushing? Positions? Spontaneous or directed?

How do you feel about perineal massage and/or episiotomy?

Would you consider forceps or vacuum if your provider recommended it?

What are your preferences once the baby is born? Do you want the baby placed on your belly immediately, or after drying off? Is separation ok or would you prefer no separation if not medically necessary?

What if a cesarean became necessary? Who do you want to support you during surgery and in recovery? Do you have special requests for baby?

Are you planning to breastfeed? If a boy, are you planning to circumcise?

Any other wishes for recovery or postpartum for you or baby? Anything special they need to know about you? Family, siblings, religious, cultural or dietary preferences?

Keep it short, simple,one page, easy to read.

Make it personal

Make it positive.

The debate has gone on for years. Many OB’s insist it’s dangerous to delay cord cutting for more than 30 seconds or the baby will get “too much” blood. Midwives traditionally delay cord cutting until after the cord has stopped pulsing, usually 2-3 minutes after birth… which is right?

An article in American Baby magazine (March 2010) makes reference to a recent study that was posted in the Journal of Maternal and Child Nutrition. “Following delivery iron rich blood continues to flow from the placenta to the infant, and clamping and cutting the cord within seconds-a common practice in many hospitals- leaves baby with inadequate blood volume. Missing out on extra iron can hinder motor and cognitive development.”

Parents, do your homework and have an honest conversation with your caregiver about your wishes.

For more information about delayed cord cutting, go to
http://birthing-options.suite101.com/article.cfm/when_to_cut_the_umbilical_cord

Finally!  A movie about doulas! It’s coming June 2010… a 65 min. documentary about 3 doulas, follows their stories, what they do and why, and what their clients have to say.  See website for a preview…

http://doulafilm.com/

With so much information available on the internet, many parents wonder if it’s worth their time and expense to take a childbirth class. Childbirth classes teach more than just  “breathing”. While a good class should include this topic in the curriculum, a thorough class will do much more.

Childbirth classes help parents learn about the normal process of birth, when to call your doctor or midwife and when to go to the hospital or birth center, what to expect during the delivery, possible variations in labor and medical interventions. They should also cover pain medications, the possibility of cesarean section, and normal recovery and postpartum. Learning all these things actually reduces anxiety during birth, allowing labor to progress normally. When labor progresses normally, there is less chance of needing medical interventions.

After taking a Childbirth Class, families report:

–Less anxiety and fear regarding their upcoming birth

–More confidence in their ability to give birth

–Dads report more confidence in their ability to support Mom

–Better communication with their caregivers

–Overall feelings of excitement and joyful anticipation of the birth of their baby.

Here’s an article that talks more about the benefits of taking a childbirth class, even when a mom is planning for an epidural:

http://pregnancy.about.com/cs/epidurals/a/cbeepi.htm

Here is a great link to a news story from ABC news about the rising maternal mortality rates following childbirth. There is clear indication the rising cesarean rate and rising induction rate may be related. Their message is clear, avoid elective inductions and cesareans unless clearly medically indicated!

http://abcnews.go.com/WN/world-news-hear-thoughts-maternal-mortality/story?id=10012018&page=1

There are differing opinions, depending on where you give birth, about the risks or benefits of eating and drinking during labor. Very traditional hospital settings restrict a mother’s oral intake to only ice chips once active labor is established. Some physicians allow clear fluids but no solids, while birth centers encourage a mother to eat if she feels she needs it, to keep her energy up and blood sugar stable.

A recent study indicates there are very few risks associated with allowing a mother to eat and drink as she wishes during labor. It makes sense her body will have the nutrients and calories needed to do the hard work of labor. If you are planning to give birth in a hospital, check with your doctor to find out their policy on eating and drinking during labor. With the right information and open communication, you and your caregiver will make a decision that’s right for you.

http://www.cochrane.org/reviews/en/ab003930.html

This isn’t a story from me… but a link to a beautifully done VBAC home video. This mom had an unplanned cesarean with her first, a planned cesarean with her second (after pressure from her physician) and elected to do a VBAC at home with her third. One of the most moving videos I have ever seen regarding birth…

http://vimeo.com/5648654