Caesareans

Dot writes: as Prawn has grown my attention has turned to issues of baby-care and development – I’m holding off on writing a big post about poo, dear readers – but this last week has brought me back to yoga and so back to birth stories. The first mother-and-baby yoga class started with telling our birth stories. I’ve also been contacting the women who attended the same pregnancy yoga class as me with a view to arranging a meeting; not all of us have had our babies yet but I’ve been finding out how it went for those who have. Though we scarcely constitute a statistically significant sample, I am struck by just how many of us yoga-mums, despite all our preparation, ended up having caesarean sections: six out of the ten women, including me, that I’ve spoken to so far. And I think most of us were pretty committed to natural childbirth; we weren’t women who just wanted to be quietly anaesthetized and unzipped; we certainly weren’t ‘too posh to push’. As a group we’re on the old side, which is a factor. But it seems a very high proportion even so. Here are some further details (though I haven’t yet heard full stories from everyone):

– two repeat caesareans. One was scheduled for caesarean, went into labour early, but her cervix didn’t dilate at all. (Come to think of it I don’t know why this woman was diagnosed as being in labour if she wasn’t dilating, but I only spoke to her briefly. Maybe this was a stalled labour.) The other was planning a VBAC but started to bleed and had a section without going into labour.
– one elective section because of a pre-existing medical condition
– one because antenatal checks showed hardly any amniotic fluid around the baby
– one breech baby. The mother had gone into labour but after a good beginning there was no dilation for four hours, so the doctors decided on a section.
– one I don’t know any details for.

The first thing that strikes me is that it’s hard to pick any of these cases and say ‘this woman should not have had a section.’ The breech baby maybe could have been born naturally if the medical staff had watched and waited, but the presenting part in a breech birth tends to be less efficient in stimulating the cervix and that certainly seems to have been the case here. The mother was in strong labour: should she have been left to struggle on?

The second thing that struck me quite powerfully was that the people who had planned sections without going into labour seemed to have a much better experience than those who had emergency sections. The woman with the pre-existing medical condition said she didn’t bother to take the pain medication she was given and that she was ‘zipping around’ even the next day. Now I certainly wasn’t zipping the next day and all I had was a second degree tear. The woman who planned the VBAC was surprised when I described a caesarean case on my ward as appearing much iller than the women who’d birthed vaginally. On the other hand, the mother of the breech baby said that, while she was prepared conceptually for being cut open, ‘nothing prepares you for the assault on your body’.

What this suggests to me is how hard it is going to be to reverse the trend towards caesareans. The trend is clearly in the wrong direction, but when it comes to particular cases the decision to operate always looks like the right one. Indeed, the anecdotal evidence here implies all these women should just have had planned caesareans in the first place.

I was so, so lucky…but why isn’t it normal to be normal?

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5 thoughts on “Caesareans

  1. womantowomancbe

    In retrospect it seems that if a woman ends up w/a C-s then she should have just planned it that way to start with, but I don’t think that is accurate. For one thing, labor is good for babies; and for another, what is a better predictor of when a baby is ready to be born than that labor begins?

    I agree with you that the breech might have been able to be vaginal; the low amniotic fluid may have been due to maternal dehydration (which means she possibly could have drunk more water and avoided her C-section), and they could have waited or gotten a second opinion on it; the “not dilating cervix” could very well have been “false” labor; and of course the one w/no details could have been unnecessary.

    In Henci Goer’s book “The Thinking Woman’s Guide to a Better Birth” (pg. 19), she noted one study in which 5 doctors were asked to review 50 cases of C-section for fetal distress, and in nearly 1/3 of the cases, 4 of the 5 said the C-section was unnecessary; but 3 months later they were given the same cases and they changed their minds in 20-40% of the cases. So even doctors can’t decide for sure if a C-section was worth it!

    Kathy
    womantowomancbe.wordpress.com

  2. Dot

    The woman with low amniotic fluid didn’t have her section until there had been a bit of a wait and repeat checks – her carers weren’t especially gung-ho about doing the operation, as far as I can tell. I agree the fail-to-dilate case sounds a bit odd; I am not sure what actually happened here. And I don’t really think all these women should have planned caesareans. I think the best way to reverse the trend towards caesarean would be to promote home birth, but this would mean a big change in the culture of childbirth in Ireland as well as in the way maternity services are organised. The birth stories I have been hearing are part of that culture and they do tend to reinforce the status quo: the birth story is a way for a woman to explain and make sense of her experience, but that can mean retrospectively justifying all the decisions that were made. When I talk to my yoga friends again it would be interesting to find out if any of them are unhappy with the care they were given – but on the other hand I don’t think I ought to prompt them to feel bad about how things went. No-one would dispute that caesarean can save some babies from death or severe disability.

    My friend with the breech baby had planned a home birth. I wonder how it would have gone for her if the health professionals had been willing to deliver a breech baby at home?

  3. womantowomancbe

    Some breeches are poor candidates for vaginal birth–their heads are looking up, which means their chins are likely to get caught on the cervix and be unable to be born in time; others have birth defects or cord entanglement issues that would mean a C-section would be preferable, etc.; but when you exclude poor candidates, the results for vaginal and breech birth are similar.

    As a “birth junkie” I also struggle with the same issues of trying to untangle the truly necessary C-sections from those that might have safely been vaginal births. I certainly don’t want to make a woman feel traumatized by her birth experience (whatever happened to her), but unless one can honestly look at a situation, there can be no change. As you said, these C-sections seem to reinforce the idea that they were all necessary.

    A couple of fellow “birth junkie” quotes–one from a doula who has attended over 750 births, “not one of them a planned C-section, but many of them managed in such a way as to make a C-section inevitable.” And, “I never tell a mom her C-section was the wrong choice; because at the time it was the right choice–it was a unique blend of circumstances–that woman, that baby, that doctor, that birthplace–and at the time it was necessary. But if she’s wanting to know how to make a different choice, what might have made a difference in her previous birth experience, then I can show her some different factors that may have influenced or changed her decision.”

    I agree with you that the best way to reverse the C-section trend is to promote home birth. At least in Ireland, home birth is more normal, and midwives are more common; here in the States, only about 1% of women per year give birth at home (including me) :-), and of the 99% that give birth in the hospital, about 90% are attended by an obstetrician.

    Kathy (you can check out my blog for more of my birth philosophy–it sounds like we’re on exactly the same page) 🙂
    womantowomancbe.wordpress.com

  4. AuntieMie

    I wanted to jump in here for a second with my two cents.

    I think there are two big reasons that it will be difficult to change the trend:

    1) MOST mothers want to do the best for their babies. So, when you hear the stories about c-sections, especially those that were done in an “emergency”, the moms chose them because thye thought they were doing the safest thing for their baby. Maybe that was because their doctor convinced them they “needed” one, or maybe it was because they were educated themselves enough to know they “needed” one. Either way, very few mom’s telling their stores out there are going to tell you that they decided on the c-section because it wasn’t the safest thing for their child. As these women tell other women, it starts to sound in the culture as if c-section must happen on a frequent occurence. It seems to me as if women knew that they didn’t have to have one (in the cases where they don’t) and don’t want to have a c-section…then they wouldn’t choose it.

    I forgot my second point and my son is crying, so I need to go, but that is part of the problem

  5. Dot

    Thanks for commenting, AuntieMie. You are right: I’m sure all these mothers wanted the safest option for their babies. And one wonders how much real choice they got about it as these things are usually presented by medical staff as the only sensible course; though, as Kathy points out, it’s very hard to be sure in many cases that a c-section really is necessary. So I don’t think it is truly a case of women choosing what is needed for their babies, but of women consenting to what their carers (in all good faith) think best. That is, I question the idea that the decision is always the mother’s (it usually isn’t) and I question a straightforward opposition between necessary and optional c-sections. It is also a matter of fact that caesareans have got enormously more common in the anglophone countries without rates of death or injury to babies improving.

    The desire to choose what is safest for the child is the prime factor in getting women to consent to procedures they don’t want – who can say ‘no, I’m putting myself first?’ It is a criticism made by opponents of homebirth and natural birth that it’s all about the mother, not the baby. But it’s not clear that all these sections actually are better for the baby. C-section is pretty safe: I don’t want to exaggerate the risks. But in a low-risk pregnancy vaginal birth, even a prolonged labour, is also pretty safe. And aren’t there risks for the baby in ensuring that his/her mother will spend the first few weeks of his/her life recovering from surgery? All the mothers I know who had sections did brilliantly, but it was certainly hard for most of them, and it’s been shown that, for example, women who have sections are less likely to breastfeed. Mothers and babies are interdependent after as well as before birth and I think it’s a mistake to see a woman’s desire for an empowering birth experience as a purely selfish thing.

    This said, I want to reiterate that caesarean can be a life-saver and that I’m sure all my friends made the best choice they could in the circumstances. In fact, and thanks to Kathy for this point too, in most cases the section probably was the right decision when it was made; the point at which it could have been averted was much further back down the line.

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