Induction and Cesarean

INDUCED LABORS AND CESAREAN DELIVERIES

by Rosemary Romberg

The large majority of labors and births proceed normally, without any problems. Nearly all women are able to give birth naturally, without any need for medical intervention. There are, however, some situations during labor and/or birth which are remedied by either induction – the artificial stimulation of labor contractions, or by Cesarean delivery – the delivery of the baby through a surgical incision in the abdomen and uterus instead of the vagina.

Both induced labor and Cesarean delivery are surrounded by considerable controversy. In some cases births have been made easier and lives have been saved by the use of artificial induction and/or Caesarian delivery. On the other hand there is also much evidence that these interventions with the natural process of labor and birth have been used many times in which labor and birth could have taken place normally without complications. Some doctors have been criticized for being overly quick to interfere with life’s normal processes.

It is helpful if expectant parents are informed about the methods and reasons for both Caesarian delivery and induced labors so that if the possibility of either is presented, the parents can understand the pros and cons and the reasons for the procedure and can make the final decision in conjunction with their doctor or birth attendant.Mom in labor

Of course a Caesarian operation is only possible in a hospital and induced labor is rarely carried out at home or in a birth center. However, if you are planning to give birth at home or at a birth center the possibility always exists that you may need to go to a hospital and have need for induction and/or Caesarian delivery. Be aware and informed about these possibilities regardless of where or how you plan to give birth.

  I. Induced Labor: Induced labor involves the starting of or speeding up of labor contractions by artificial methods. There are several ways that labor can be induced.

1. “Stripping the membranes”
This procedure involves going up inside the cervix and separating the amniotic membranes away from the sides of the cervix without rupturing them. Sometimes this will bring on labor contractions

2.Rupturing the membranes
By this process the doctor or birth attendant uses a small device that looks like a crochet hook, reaches inside the cervix, and artificially breaks the amniotic membranes. Sometimes this will start labor or speed up a slow labor. If the internal fetal heart monitor is to be used, small electrodes are inserted directly into the baby’s scalp or presenting part. The membranes must be ruptured before this device can be applied

Meconium (the baby’s first bowel movement) in the amniotic fluid is an indication that the baby is in distress. Some doctors argue in favor of artificial rupturing of the membranes so that they can see whether or not the amniotic fluid is clear.

Artificial rupturing of the membranes, (the technical term for this is amniotomy), is a two-sided issue. One argument against this procedure is the fact that once the membranes have been ruptured there is no turning back. Once the membranes have been ruptured, the danger is present that infection of the uterus could set in if the baby isn’t born within a reasonable amount of time. Therefore, if the membranes are ruptured and regular labor contractions do not result it usually is necessary for the doctor to use other, chemical means of inducing the labor contractions. The possibility always exists that the mother was only having false labor and the baby wasn’t really ready to be born.

Another consideration is the fact that if the membranes remain intact throughout labor, this provides a protective cushion for the baby’s head as each contraction presses against the cervix. The cushion of membranes and fluid, if present, take most of the pressure from each contraction. If the membranes have ruptured then the baby’s head (or presenting part) experiences more direct pressure as the contractions push it against the cervix. While it is highly questionable that this results in any permanent damage to the baby, there is often more molding to the baby’s head when the membranes have ruptured early.

3. Use of an oxytocic drug
Oxytocin is the hormone that a woman’s body produces in just the right amount, that causes the uterus to contract normally when it is time for her to go into labor. Pitocin is the synthetic equivalent of Oxytocin. The drug Pitocin is what is most commonly used by the medical profession when they wish to induce or stimulate labor by a chemical means. There are a number of different ways in which Pitocin can be administered.

Buccal Pitocin
These are chalky, tasteless tablets which are held in the side of the mouth. Usually several are given at half-hour intervals. The drug is absorbed through the veins in the cheeks.

Intra-muscular injection
Sometimes women are given a shot of Pitocin during labor. Usually this is done to speed up a slow labor.

Intravenous drip
The Pitocin is diluted with glucose water and is administered into a vein. Beneath the bottle of intravenous solution as it goes into the plastic tube is a valve which can be controlled. By controlling the rate by which the solution drips into the tube and into the mother’s vein, it is possible to control the frequency and intensity of the contractions. For many medical professionals this is the preferred method of chemical induction of labor. The birth attendant can more directly control and observe the amount of Pitocin that the woman is getting with an I.V. than with tablets or a shot.

4. Home Remedies for inducing labor

Castor Oil: Castor oil is a strong laxative which causes intestinal contractions which may in turn stimulate contractions of the uterus, if labor is soon to begin anyway. Sometimes doctors or birth attendants recommend castor oil to mothers who are overdue or have some other reason that inducement might be a good idea. Sometimes impatient mothers who have gone past their due dates ask about taking castor oil. Sometimes women take castor oil, feel yucky and nauseous as a result, but do not go into labor. Castor oil has an extremely unpleasant aftertaste which discourages some mothers from trying this method

    Be sure to discuss the matter with your doctor or birth attendant before taking castor oil or trying any other home remedy at any time during pregnancy including labor.

Enema: Sometimes an enema given during early labor will stimulate labor contractions. This is one of the reasons that in some hospitals enemas are given routinely to all women in labor. (Many people, however, question routine enemas.) In a few instances drugs to stimulate labor contractions are added to the enema.

A mother can give herself an enema at home during early labor if she desires and if her doctor or birth attendant agrees to its use.

Herbs: There are some herbal mixtures, taken as teas, which are purported to stimulate labor contractions. (Cohosh and Pennyroyal for example.) In actual practice it is questionable how effective some of these herbs truly are.

Not all herbs are harmless. There are some herbs that should not be taken during pregnancy. Confer with your birth attendant or someone who is knowledgeable about the use of herbs before you use any during pregnancy or labor. (Medical doctors are not usually knowledgeable about herbs.)

REASONS FOR INDUCING LABOR:Medication

1. Sometimes if a mother has a small pelvis, the doctor may decide that she should be induced as soon as she is full term, before her baby grows too large. Babies in utero do a great deal of growing during the final weeks of pregnancy.

2. If the mother has gone 3-4 weeks or more past her due date, many doctors choose to induce. If this happens, many decisions must be made. There is the possibility that the due date was inaccurate and the mother did not conceive as early as she thought she had. There is the possibility that she is a ten-month gestater. Some women simply have longer pregnancies than others, and nine months is just a rule of thumb. However, there is a true danger if the baby is post-mature. Once the pregnancy has gone 2-3 weeks past the optimum due date, the placenta begins to deteriorate and decreases in its efficiency. The post mature baby often loses weight in utero. She/he may be a long, skinny baby weighting around 7 lbs. The same baby may have weighed 8-9 lbs. at term. Babies like this usually do all right once they can take nourishment outside the womb. But often post-mature babies do have problems and are not as healthy as babies that are born closer to the due date.

3. If the membranes rupture and regular labor contractions do not begin within a specified amount of time, most doctors choose to induce. There is a danger that an infection of the uterus could develop once the membranes have ruptured. Some doctors induce mothers who do not go into labor 12 hours after the membranes have ruptured. Some wait 24 hours. Others wait longer. This practice has become a two-sided issue, for there are cases in which mothers have waited several days before going into labor after their membranes have ruptured and have had no problems. If a mother chooses not to be induced after her membranes have ruptured, it is important that she be observed carefully for any signs of infection. In the case of a mother threatening to deliver prematurely it can be extremely advisable to keep the baby inside her, if possible, until she reaches or gets closer to her due date.

4. If the mother has an illness that is associated with pregnancy, such as toxemia, it may be strongly advisable for the baby to be born as soon as possible. Induction may be done for this reason.

5. Sometimes a method of induction is used to speed up a labor that is already underway. This is also a controversial issue.

Psychological factors figure strongly in how effectively labor will progress. If a mother is frightened or feels restless and uneasy, this can result in a slow sluggish labor with irregular, ineffective contractions. Medical professionals call this uterine inertia in which the mother has contractions which are uncomfortable, but are not strong and effective enough to dilate the cervix. If this is the case, usually changing the scene, getting rid of disturbing people or situations, or giving her reassurance, can do a great deal towards helping her to feel better and have more satisfactory progress with her labor. (Of course if the birth is taking place at home, you have much more control over what you can and cannot do at this time. you can easily get rid of a troublesome person who is in your own home. It is harder to get rid of a crabby or unhelpful nurse or attendant in a hospital.) Often the solution of chemically inducing labor is not the best recourse during labor.

Some women, especially first time mothers, simply have labors that take a long time. This does not necessarily mean that the labor is complicated or that there is anything wrong with her. Usually most of this is mild, early labor contractions which are not greatly stressful or challenging. Some women have been in early labor for days, and have subsequently had natural, uncomplicated births.

The woman who is having a long early labor stage should, in most cases, be at home, even if she plans to go to a hospital or birth center for giving birth. At home she is free to walk around and keep busy during early labor, and thus the time should pass quickly for her. If she is confined to a bed in a hospital or birth center, the hours of early labor can drag and will seem unbearable! There is a tendency for parents and medical personnel to become impatient with a normal, slow labor such as this and want to intervene simply to speed things up. As a result, many women have had their labors chemically induced, (and if the induced labor was not effective have been delivered by Cesarean!) simply because they were having normal but long labors.

Additionally, sometimes women are given medication of a sedative-type nature during labor. Medication such as this can slow down labor contractions and sometimes doctors induce labor for this reason. Sometimes women find themselves in an unfortunate vicious circle of sedative drugs and drugs for induction. This is a strong argument in favor of use of methods of natural childbirth and giving birth without medication.

6. Convenience induction: Some mothers and doctors choose to schedule the baby’s due date. If induction is being done for convenience it will not be done unless the head is engaged in the mother’s pelvis and the cervix has begun to efface and dilate.

Convenience induction is a highly controversial issue. There is much evidence that both the mother’s body and the baby know when is the best time for the baby to be born. Inducing labor for convenience’ sake is definitely going against the course of nature.

The possibility always exists that the mother may not be as far along as she thought she was and there may be some condition that will result with the baby not being quite ready to be born, that would not have happened if labor had begun when the mother’s body was ready to go into labor.

There is considerable evidence that the baby is under more stress when labor is chemically induced. The baby’s heartbeat normally slows down some when the uterus is contracting. With induced labor the contractions are both stronger and closer together. As the uterus contracts the baby receives less oxygen, and with induced labor this is more pronounced.

Chemically induced labor also poses additional risks to the mother. Because the contractions stimulated by induction are usually stronger and closer together than spontaneous labor contractions, the mother whose labor is induced is more likely to sustain damage to her uterus or birth canal and is more likely to bleed excessively following delivery.

Today, many birth attendants are aware of the risks involved with induced labor, and convenience inducing is not as popular as it once was. If your birth attendant suggests induction for convenience’ sake, the final decision should be yours.

Important things to know about induced labor:

1. Induced labor contractions are usually stronger and closer together than natural labor contractions. Chemical inducement also speeds up the process of labor, usually making labor shorter than it would have been on its own. Induction is not a contraindication to having an unmedicated birth by any of the methods of natural childbirth.

2. There are two terms that refer to the condition of the uterus and cervix when a woman is in late pregnancy—”ripe” and “green.” If the cervix is ripe it has begun to efface and dilate and the baby’s head is well engaged into the pelvis. If the cervix is green it is still long and thick and the baby’s head or presenting part is still high up in the pelvis. If the mother’s cervix is ripe, in most cases her body is ready to go into labor at any time. If she is chemically induced at this time, induced labor will probably not be significantly more difficult than normal labor. If the mother’s cervix is green, her body is not ready to go into labor. If she is chemically induced at this time, induced labor can be very long and difficult.

3. Use of the Fetal Heart Monitor: The fetal heart monitor is an electronic device which records the mother’s contractions and amplifies and records the baby’s heartbeat during labor. Some electronic heart monitors are merely small microphones which are placed on the mother’s abdomen and simply amplify the baby’s heartbeat. Other more complicated fetal heart monitors record both the mother’s contractions and the baby’s heartbeat onto graph paper similar to a computer print-out. The baby’s heartbeat can be monitored either externally or internally.

With external monitoring, a microphone-type device is placed on the mother’s abdomen during labor in an area where the heartbeat can be easily picked up. It is either taped in place or held in place with a belt. The heartbeat can be easily heard when the external heart monitor is used.

With internal monitoring, the mother’s amniotic membranes must be ruptured. Electrodes are inserted into the baby’s scalp or presenting part. This method gives a more direct, accurate recording of the baby’s heartbeat than the external monitor The fact that the membranes must be ruptured has caused many people to criticize this method. Many parents also express concern about the fact that the electrodes are painful for the baby. Additionally, babies occasionally have developed abscesses on the scalp (or presenting part) at the site where the electrodes were attached.

Electronic fetal heart monitors are available for use in virtually all hospitals. Different birth attendants feel differently about how and when monitoring should be used. Some wish to use the internal monitor on all mothers in labor. Others use the external monitor routinely on all mothers, and only use the internal monitor if something is in question. Sometimes birth attendants wish to use the fetal heart monitor for just a short time during labor, perhaps 1/2 hour, in order to see how the contractions and heartbeat appear on the graph. Then they will not continue to use it as long as labor is proceeding normally. Some birth attendants choose not to use the monitor at all as long as labor is progressing normally.

Most birth attendants choose to use the fetal heart monitor in some manner if labor is to be induced by a chemical means. Because artificially induced labor puts greater stress on the baby than normal labor, his/her heartbeat should be watched closely. If you watch the read-out from a fetal heart monitor, one line will indicate the mother’s uterine contractions while another line indicates the baby’s heartbeat. The rate of the baby’s heartbeat will slow down as the contraction peaks, and the heartbeat will resume its normal pace as the contraction subsides. Less oxygen goes to the baby during contractions. Since contractions which are induced by artificial means are stronger and closer together, the baby is deprived of more oxygen than during regular labor. Most babies that are born by artificially induced labor are perfectly healthy. However, this is one of the reasons that many birth attendants are now choosing not to induce for convenience’ sake.

Electronic fetal heart monitors have been both widely praised and widely criticized. Proponents have claimed that the device has saved lives by occasionally detecting a baby that was in distress that could then be taken by Caesarian operation that may have been lost were it not for this machine. Critics of the device have stated that it is an unnatural electronic interference in what should be a natural body process. The machine is very noisy. It greatly restricts the mother’s freedom of movement. Many women find the wires coming out of their vaginas a disturbance. The possibility of the mother developing an infection of the uterus is greater when this device is used. It is a mechanical substitute for more personal attention, and it has resulted in many unnecessary Caesarian deliveries.

Undoubtedly the fetal heart monitor can be a beneficial tool in some specific situations. However, its value in routine use on all mothers in labor is highly questionable.

It is highly advised that expectant parents discuss the use of the fetal heart monitor in advance with their birth attendant so that they will know in what types of situations he/she will and will not use it. Make sure that your birth attendant’s policies on this are agreeable to you.

Cesarean Birth: Doctor and newborn
A Cesarean delivery is a major surgical operation in which an incision is made in the mother’s abdominal wall and uterus and the baby is born by this method rather than through the vagina.

A common term for Cesarean birth is “C-section.” However, some mothers, especially proponents of Cesarean support groups, are uncomfortable with this term. A Cesarean delivery is understandably frightening and disappointing for many parents. Wording such as “Cesarean birth” reassures such parents that the experience is indeed a birth, even if surgical, while the term “C-section” may seem cold and impersonal.

Midwives are not qualified or trained to perform Cesarean operations. Because it is surgery, a Cesarean must be done by a doctor. Most midwives who work in cooperation with a hospital are able to contact one or more doctors who can take over in this event. Some family doctors (general practitioners) who regularly attend vaginal births choose not to do Cesarean deliveries, and refer their patients who need such surgery to an Obstetrician.

While a birth attendant can easily attend to the needs of both mother and baby following an uncomplicated vaginal birth, a Cesarean delivery requires a second doctor in attendance to examine the baby. A pediatrician or family practitioner is usually enlisted for this purpose.

Most commonly, spinal anesthesia is administered for a Cesarean operation. The anesthesia is directed upward in the spinal column so that she is numb from the level of the breastbone down. The mother is conscious and aware of the baby’s birth and feels pressure, but no pain. Her body is entirely draped so that only the area being operated on is visible. A barrier of sterile drapes is set up at the level of her shoulders so that her breath won’t contaminate the sterile field. Because of this she cannot see the operation or the birth. In some hospitals they will set up a mirror for the mother so that she can see the baby’s birth if she desires this. The incision and birth of the baby take place very quickly.

Usually the baby is shown to the mother as soon as he/she is born. In some hospitals the Cesarean mother is allowed to hold her baby on the operating table shortly after birth if she desires this and the baby is healthy.

After the baby is born, the process of being sewn back together takes about an hour. First the uterus and then the outside skin must be stitched. Some doctors prefer to give the mother general anesthesia after the baby is born so that she is not awake during the more lengthy process of being stitched. If she is given general anesthesia, she will then sleep several hours after the operation and there is a delay in how soon she will get to be with her baby. Sometimes doctors deliver the baby and repair the incisions under spinal anesthesia only. Many women find this preferable as then the baby can be brought to them in the recovery room as soon as the operation is over.

In some cases the Cesarean operation is performed under general anesthesia only, with the mother asleep for the birth. This is the preference of some doctors. In some cases, especially when Cesarean birth was a sudden decision, mothers are too frightened to be conscious and awake for the operation and choose to be put under with general anesthesia. General anesthesia may be the preferred method in cases in which time is an important factor. In the case of a Cesarean delivery which must be done because of a sudden emergency, general anesthesia can be administered much more quickly than spinal anesthesia.

Reasons for Performing Cesarean Deliveries:Surgery scene

1. If the membranes rupture and the umbilical cord starts to come out ahead of the baby, usually an immediate Cesarean delivery is performed. The pressures of the baby’s head or body against the cord during contractions can compress it and cut off the baby’s blood supply. This occurrence is extremely rare. Usually when the membranes rupture, the head comes down and acts like a stopper. A cord prolapse is more likely to occur with a breech presentation or in a case where the cord is unusually long.

This is one of the reasons that it is important to get immediate medical attention if your membranes rupture (i.e. if your water breaks). If you are at home, on your own and your membranes rupture, call your doctor or birth attendant immediately. If you are in the hospital or birth center, or if your birth attendant is already present for home birth, let them know immediately if your membranes rupture. Probably the first thing that they will do will be to check the baby’s heart beat. In some cases of cord prolapse the cord can be felt and/or seen slipping down into the vagina. In other cases it does not slip down this far, but it does get in front of the baby’s head and pinch off its oxygen supply. If there is a sudden, drastic drop in the baby s heart beat rate, immediately after the membranes have ruptured this almost certainly means that the cord has become pinched. Unless actual birth is imminent a Cesarean operation will probably be performed.

In the rare event of a cord prolapse occurring at home, the book Emergency Childbirth by White, gives the following instructions: The mother should assume a knee-chest position and wrap a warm, wet washcloth loosely around the cord if it is out of the vagina. If possible, another person should reach into the vagina and push the baby’s head or presenting part up and off the cord so as to allow blood to go through it. She should get to the hospital in this position immediately, by ambulance if a car is not readily available.

2. If the placenta is implanted low in the uterus, so that it covers the cervix (placenta previa) a Cesarean delivery is necessary. The mother would lose too much blood and the baby’s life would be threatened if the placenta were to be born first. In most cases this complication is preceded by vaginal bleeding. This is one of the reasons that you should immediately notify your doctor or birth attendant if you experience any vaginal bleeding.

If a placenta previa is suspected during pregnancy, sometimes the hearing of the placental sounds through the fetascope or heart monitor in the lower part of the uterus or failure to feel the baby’s head or presenting part in that area both suggest the possibility of placenta previa. Detection of the site of the placenta by an ultrasound reading can help confirm or rule out this possibility.

3. If the placenta begins to detach before the baby is born, this can be very dangerous for the baby, and often Cesarean delivery is performed. Sometimes this complication results in vaginal bleeding. Frequently the mother experiences severe pain in the area where the placenta is separating. If the placenta begins to detach, often the baby’s heartbeat changes drastically, becoming either very rapid or slowing down considerably.

Placenta abruptio can be caused by an injury to the mother, or can be related to poor nutrition which results in a weaker placenta which separates more easily.

4. If the mother has a small pelvis or a pelvis that is abnormal and the baby is too large to pass through it, a Cesarean operation is necessary. Sometimes this is determined by an x-ray or ultra-sound reading that measures the baby’s head at term and the size of the pelvis. Sometimes this is determined when the mother pushes for a number of hours but makes no progress.

5. If the mother has an active case of genital Herpes infection, this can endanger the baby’s life if born vaginally, so a Cesarean delivery is the preferred method of delivery.

6. If the baby is presenting sideways with an arm or shoulder presenting and the doctor or birth attendant is unable to turn the baby to a head down or breech position, the baby will have to be born by Cesarean.

7. A Cesarean delivery is sometimes performed if the mother is terribly ill and she and the baby would both fare better if the baby was born as soon as possible. (For example – toxemia.)

8. Many doctors perform Cesarean operations if the baby is in breech position (feet or bottom first), especially if this is the mother’s first baby. When a baby is born vaginally by breech presentation, as soon as the lower half of its body is out the head will compress the cord against the mother’s pelvic bones and the baby no longer gets blood from it. Therefore the baby must be completely born as quickly as possible. A great deal of skill and knowledge is necessary in dealing with vaginal breech presentations. Some doctors prefer to take the more conservative route of performing a Cesarean operation rather than run the risks of a breech delivery. Some doctors are simply not skilled and knowledgeable in delivering babies by breech presentation.

On the other hand, many, many babies have been born vaginally in breech position without any complications or adverse after-effects. Some doctors will deliver some breech babies vaginally and others by Cesarean, taking the size of the baby and the dimensions of the mother’s pelvis into consideration. In addition, some babies that are presenting breech do turn to a head down position in late pregnancy or even during labor. The question of automatically performing a Cesarean delivery in all cases of breech presentation has been open to a great deal of criticism.

9. In some cases if the mother has simply been in active labor for a long time and is not dilating or progressing very fast, some doctors will resort to Cesarean delivery. This practice is also controversial. Some women simply do have long labors which will result in a satisfactory vaginal birth. Frequently psychological factors will contribute to a slow labor and failure to dilate. Changing the scene can often be a better remedy than surgically intervening. On the other hand, a woman who has already been through many hours of difficult, challenging labor, who is becoming exhausted and discouraged, can certainly be understood if she accepts a Cesarean birth over the prospect of several more hours of hard labor. “I don’t care what you do—just get it over with!!” can be a typical attitude.

10. Sometimes if there is a sudden drastic change in the baby’s heart rate, this may signify that the baby is in distress, (for example, the cord may be pinched) and the doctor may do a Cesarean delivery.

The widespread use of the electronic fetal heart monitor during the past few years has resulted in an increased amount of Cesarean deliveries. In some cases babies’ lives have been saved by Cesarean birth – a problem being detected early by the fetal heart monitor. In other cases mechanical failures with the monitor, incorrect interpretation of the readings, or over-cautiousness on the part of the doctor has resulted in the Cesarean deliveries of babies that could have been born vaginally with no problems.

11. Today most doctors follow the rule that once a mother has had a Cesarean delivery, all subsequent babies must also be delivered by Cesarean. In some cases such as a small or abnormal pelvis that would obstruct future births, this cannot be questioned. In other situations that would have no effect on a future pregnancy or births such as a breech presentation, the practice of routine repeat Cesarean delivery has been questioned.

Many women have experienced successful, uncomplicated vaginal births after giving birth to previous babies by Cesarean delivery. (Today this is commonly referred to as “VBAC” – for vaginal birth after Cesarean) There is a small danger that the old incision in the uterus could rupture during a future birth, and the results of this can be disastrous! However, some mothers choose to accept this small risk so that they can have the experience of a natural, vaginal birth. The possibility of a uterine rupture is greater if the Cesarean incision was cut up and down the mother’s abdomen (“classic” incision) than if it is a “bikini” cut which goes straight across the area above the pubic bone.

If you have had a previous Caesarian birth and would like to have a vaginal birth with a subsequent pregnancy, you should seek a birth attendant and hospital who are agreeable to allowing you to try this and can closely evaluate and monitor your situation. Some mothers have successfully given birth at home or in birth centers following previous Cesarean deliveries. Midwives’ personal rules about what type of conditions they will and will not accept among the mothers they attend can vary greatly, and many will not accept mothers in this situation.

Things to Know and Consider About Cesarean Birth:

As recently as the 1950’s and early 1960’s about 98% of all births were vaginal births, with only 2% delivering by Cesarean. By the 1980’s the rates of Cesareans in American hospitals range from around 10% to 35% or more. It is highly doubtful that women’s bodies could change so radically in just one generation. Instead doctors’ attitudes and practices have changed drastically during those years.

Some Cesareans are definitely life-saving measures and their value is unquestioned. For example if a woman has a small pelvis and the baby is too large to pass through it, Cesarean delivery is the only way that she could successfully give birth. Such a woman should be thankful that she lives in a day and age that Cesareans can be done safely.

Other reasons for Cesareans, such as breech presentations, long labors, or questionable fetal heart rates – probably in most cases could result in a satisfactory vaginal birth, but the doctor has chosen to be cautious. Many have suggested that the problem of malpractice suits and rising malpractice insurance rates have caused many doctors to be overly conservative and ready to do Cesareans at the slightest deviation from a normal labor. Expectant parents should be aware of this. If the possibility of a Cesarean arises, you should know the reason why it is indicated. You have the right to seek a second opinion from another doctor if the reason is questionable. You should have a voice in the final decision as to whether or not you will give birth by Cesarean.

A Caesarian delivery is major surgery. The hospital stay and recovery period are somewhat longer than for women giving birth vaginally. A mother who is given general anesthesia for the operation usually awakens a few hours after the birth. A mother who is given spinal anesthesia for the surgery must lie flat and not lift her head for a number of hours after it is administered.

Surgery

Uncomfortable but necessary procedures that accompany the Cesarean operation include: An I.V. during and after the operation, catheterization during the operation to keep the bladder empty, and a liquid (post surgical) diet for the first couple of days after birth. (The hospital fare consists of such things as Jello and 7-up. Some mothers have chosen to have their husbands or other friends bring in natural fruit juices and herbal teas instead.) Many mothers experience uncomfortable gas pains during the recovery period. Also the incision is usually very sore for the first few days. The Cesarean mother experiences vaginal bleeding following birth as does the mother who has delivered vaginally. A helpful suggestion is to use sanitary pads with an adhesive strip that attaches to the underpants. This eliminates the need for a belt which can irritate the incision.

While the mother who has experienced an unmedicated  vaginal birth can get up and walk around shortly after birth and usually can easily tend to her own needs with little or no help from others, the Cesarean mother must depend on the nurses for assistance for the first few days. Often just sitting up, walking across the room, or going to the bathroom can be very difficult.

Some communities offer Cesarean Preparation classes which can be extremely informative if a Cesarean birth is anticipated. Some hospitals now allow the father or labor coach to be present in the operating room for Cesarean birth. (Unfortunately in some hospitals the father or labor coach is only allowed in the operating room if the couple took a Cesarean preparation class. This is of little use to the couple who undergoes a sudden, unexpected Cesarean!) As long as the baby is healthy, there is no reason that the father cannot hold the baby shortly after birth.

In many hospitals the policy is to observe babies delivered by Cesarean very carefully. The Cesarean baby is at somewhat greater risk than the vaginally born baby. When a baby is born vaginally, the pressure of the birth canal around its body stimulates its breathing mechanisms to work. The baby born by Cesarean delivery does not have this advantage. While most babies born by Cesarean delivery are perfectly healthy, this is the reason that medical personnel are careful about observing the condition of the baby.Nursing mom

However, a mother can certainly still nurse her baby if she has a Cesarean birth. Many women have found that feeding their babies with their own bodies by breastfeeding compensates for the disappointment over not giving birth naturally. The Cesarean mother can still have rooming-in if the hospital offers it. She will probably be too sore from the operation to begin rooming in immediately after birth.

Once the Cesarean mother and her baby are home from the hospital, she will need somewhat more rest, more help, and have a longer period of recovery than the mother who delivered vaginally.

It is not uncommon for mothers to experience a sense of disappointment and perhaps depression following a Cesarean delivery,especially if they have taken classes in prepared childbirth and had planned to have a natural birth. Especially in cases in which the reasons for the Cesarean were questionable, such mothers often feel anger at their doctor or a sense of failure in themselves that they were unable to give birth “the right way.” Some mothers experience a great deal of psychological difficulties, guilt, depression, etc. in the aftermath of a Cesarean birth. Other mothers are easily able to take Cesarean birth in stride and are simply happy to have a healthy baby.

The mother who is undergoing depression due to disappointment over having had a Cesarean should be assured that these feelings are normal and very common for many women. Cesarean support groups which not only prepare couples for Cesarean births, but help people with their subsequent feelings and adjustment, can be of immense help in these cases. Your doctor, hospital representatives, childbirth instructor, or La Leche League leader can put you in touch with a local Cesarean support group, or with other parents who have been through the same experience and can understand your feelings.

c.1982  (Revised – 2012)


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