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How to Avoid a C-Section

August 23, 2007

CNN has a new entry in their listy health pages, focusing on five ways to avoid having a cesarean section.

The suggestions are:
1. Don’t get induced unless medically necessary [medically necessary happens less often that you think]
2. Labor at home until you’re approximately 3 centimeters dilated
3. Choose your hospital, and your practitioner, carefully
4. In the delivery room, ask questions if your practitioner says you need a C-section
5. Get a doula [I would add, or use a midwife]

Go read why these suggestions are important.

PS- Old folks get it on

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56 Comments leave one →
  1. August 23, 2007 1:13 pm

    I want to thank Elizabeth Cohen for writing such an important article and emphasizing that women have choices and options about how they wish to handle their birth.

    Websites like MyBirthTeam.com are all about providing women with more information so the choices they make about their healthcare/birth are done through education and empowerment rather than being spoon-fed information.

    We all have the ability to take more control about our healthcare and Elizabeth Cohen’s article brings to light that the responsibility is ours.

  2. August 23, 2007 1:18 pm

    Richard,
    Thanks for your comment; Ms. Cohen did a good job with that piece. I’m planning on spending some more time on MBT and putting something up soon, by the way.

  3. Jennifer permalink
    August 23, 2007 1:33 pm

    It’s too bad she didn’t add “plan a home birth or a birth at a free-standing birthing center”.

  4. August 23, 2007 1:39 pm

    Jennifer,
    Good suggestion. I was completely blown away by a traditional mass media outlet pointing out how size estimates are often wrong and induction happens too frequently, though! I don’t feel like I’ve seen much of that outside of midwife/advocacy sites until recently.

  5. Gogi permalink
    August 23, 2007 1:58 pm

    I agree with not getting induced unless it is necessary but in some cases c-section might be a better option.

    Looking back.. I so wish that I had a c-section. I had a difficult birth that included dilation, inducing and extraction. The baby was quite big for my pelvic size.

    What made my experience worse was the RV fistula and stress that followed. I so wish I just had c-section instead of experiencing this horrible experience, a fistula correction surgery and fear to even do normal things in my life.

  6. August 23, 2007 1:59 pm

    Rachel,
    Just one more comment that relates to your suggestion about midwives are a good option along with a doula: There are many women who don’t realize that a midwife is a viable option along with an obgyn. I think that is GREAT that you mentioned that.

    Also, I am glad that you will take a closer look at MyBirthTeam. I think this is an important site as it matches patients and caregivers together to ensure that the philosphies are a good fit in the type of health care being rpovided. The Amercian College of Nurse Midwives (ACMN) have just recently announced a partnership with MyBirthTeam.com (last Friday) to try to promote midwifery services.

    Woman need to know about their options when it comes to birth and be able to make educated choices about one of the most meaningful events in their lives.

    Thanks for listening Rachel.

  7. August 23, 2007 2:26 pm

    I planned a home birth, had a doula, midwife, resisted induction even when I was two weeks overdue and still ended up with a c-section. But – I did feel that I had done everything I could to avoid it.

  8. Angela M permalink
    August 23, 2007 3:05 pm

    I’m glad they mentioned that there are indeed several situations that make a c-section medically necessary. I had an emergency c-section (placenta previa) and it was a situation where we needed to get the baby out within minutes. They couldn’t even wait for anesthesia. (I most emphatically do not recommend this.)

    Many people who are against c-sections make it sound like all of us chose to do so because it was convenient for our schedule, or we’re too lazy to push, or we’d prefer a cute little bikini cut over massive stretch marks. I have a gigantic, horrific scar from belly button down that says otherwise.

    And while I think homebirthing is a great option for some, if I had tried it I would definitely be dead now. We had no idea that I had placenta previa until the very last minute. Yes, women have historically given birth at home – and many of them died. Sometimes, we forget that.

  9. Michelle permalink
    August 23, 2007 3:34 pm

    Interesting and informative blog. But, what I don’t understand is why such an adverse reaction to c-sections? I chose to have a c-section, planned, ahead of time, at 39 weeks, and it was the most wonderful experience of my life. It was not medically necessary, it was what I wanted. Please don’t post nasty replies, about how natural child birth is the best way, etc etc. Believe me, I’ve had plenty of criticism and nasty responses based on MY decision. I guess I just don’t get all the hype surrounding c-sections. If it’s what a woman wants, and it’s not a danger to herself or the baby, then what’s wrong?

  10. August 23, 2007 4:22 pm

    Hi Michelle,
    I hope you don’t mind me responding to your blog entry. First of all, let me say that I am a guy and I do not pretend to understand what its like for a woman to go through childbirth either naturally or with a c-section.

    However, I do have some experience and insight into the question that you asked in regards to the adverse reasctions to c-sections. Essentially, many c-sections are performed unnecessarily. C-sections are major abdominal procedures with a longer recovery time than natural birth. And some doctors may push c-sections for various reasons that may not be medically necessary.

    Having said that, it sounds as though you made a conscious choice to have a c-section. That’s great!. That worked for you and that was a decision you made and you are obviously very happy with it.

    However, some women are not aware that they have choices. Some women are not aware that there are alternatives and they think that c-sections are the only options available.

    And many woman may opt for a natural childbirth and wind up getting c-section anyway because there was a true medical need for it.

    But women really need to be educated and informed about the choices available to them and realize that they have options about the kind of birth they want. Once they are informed, then they can make the decision that is best for them personally, whether its natural or a c-section.

  11. August 23, 2007 4:23 pm

    Michelle – I think the “adverse reaction” is to women being told that they medically need c-sections when they really probably don’t. C-sections do carry risks, and I might not necessarily agree with your choice, but it was yours to make. When women aren’t truly informed by their physicians (other otherwise) about what is necessary and evidence-based and what is not, that isn’t a truly informed choice.

    Angela – I think your comment points to how all women and births are different, and a standardized approach of “you must be induced, this baby is too big, you must lie down” it not appropriate to use across the board.

  12. Allison permalink
    August 23, 2007 6:14 pm

    The goal is all the same–to have a healthy child. Too many people focus on the means and moms are made to feel guilty or as ‘failures’ for having a C section. In the end the process of childbirth is not nearly as important as the outcome.

  13. cmac permalink
    August 23, 2007 6:17 pm

    As a registered nurse, I know that every woman, and every pregnancy, is different. Mother Nature has the final say – the most important point here is to talk, talk, TALK to your doctor, ahead of time; mid-labor is not the time to be pushed to make decisions. I had a spontaneous rupture of membranes, was in labor for 22 hours after they ruptured, never progressed beyond 5 centimeters, and ended up having a C-section. My daughter was born with a distinct ridge in her skull where her skull and my pelvis had a debate. Had we insisted on trying a natural birth, she would have needed to be delivered using forceps high in the birth canal, which can cause serious problems; her skull would have lost the debate. I was grateful for my unplanned section for her, and my planned section for her younger brother 2 years later. Yes, there are probably more C-sections than necessary, but when properly selected, they absolutely save lives and unnecessary suffering.

  14. August 23, 2007 6:19 pm

    Allison, thank you for your comment and I can understand where you’re coming from. I don’t think women should be made to feel like a failure if they end up with a c-section. Some women no doubt need a c-section. I think there is a kind of failure in the system that convinces some women that they need a c when they really don’t. I would like to share this perspective from a woman who is tired of hearing that a healthy baby is the only thing that matters, though, because I haven’t heard that particular perspective expressed so clearly before.

    Thank you all for your comments and for being quite civil about an often touchy subject. I hope we can continue to have these kinds of conversations.

  15. August 23, 2007 6:21 pm

    Cmac, I think you and I were typing at the same time. Thank you as well for sharing your story. Your advice to TALK is very important. Might I add, “her skull and my pelvis had a debate,” is a turn of phrase that delighted me, if you don’t mind my saying so.

  16. Hildy permalink
    August 23, 2007 6:50 pm

    Although these are excellent suggestions, I think point 4 is a bit overstated: there’s no evidence that you can predict CPD in advance using pelvimetry etc, but that is a matter for the OB office before you get to the delivery room. Once you’re actually in the delivery room labouring, failure-to-progress/obstructed-labour/cephalopelvic-disproportion are all reasonably clear indications for C-section, especially if the baby isn’t at 0 station yet (the biggest part of the head past the smallest part of the pelvis). That size estimates are often wrong is irrelevant – the baby getting stuck is reasonable evidence that it is too big for that particular woman’s pelvis.

    Cmac: it’s good that you didn’t insist; high forceps deliveries are essentially malpractice if offered.

    Rachel: although the goal is healthy mother, healthy baby, Gretchen seems to have political/philosophical problems with the very concept of C-section, and appears to be upset that these viewpoints weren’t regarded as important. If you want to have a spontaneous vaginal delivery, all power to you – and these tips are an excellent way to achieve that – but when you are disappointed, it may be because you set your sights too high. It’s like applying to medical school, not getting into HMS, and having people tell you that “at least your dream of being a doctor will come true” – they may be trying to assauge the hurt, but at the time, it doesn’t really help.

  17. August 23, 2007 7:17 pm

    Hildy, when I think of the size issue, I always think first of a friend of mine who was told several weeks prior to her due date that the baby would be too big and she would have to have a c-section. It turned out that the size estimate was 2lbs or so off, and I’ve heard this same scenario repeated from other women. I think that’s the bigger problem, telling women they won’t be able to before they’ve ever even tried, and that’s usually what I’m referring to. I suspect that’s what the CNN author was referring to as well, but of course am not certain. I don’t mean to suggest that it never, ever happens during labor that the baby won’t come out for one reason or another. I also think you raise an interesting point – while helping women to ask for more appropriate and better care, they may also be more disappointed when things don’t go as planned. I think starting with good communication, a provider you can work with and who takes you seriously, while acknowledging that things may not go according to your checklist, is a good plan.

  18. August 23, 2007 7:27 pm

    Vol Abroad, I wanted to make sure to acknowledge your comment and say I hope you and the little one are doing well. I do get a kick out of those “big orange” outfits. 😉

  19. Kathryn permalink
    August 23, 2007 8:53 pm

    I think saying “In the end the process of childbirth is not nearly as important as the outcome” might be a little shortsighted if you’re not considering future pregnancies. Having a cesarean for your first child’s birth inevitably makes any subsequent pregnancies less safe. The chance of having a uterine rupture along the old scar line still exists, even if an elective repeat cesarean is chosen for subsequent deliveries and the mom never labors at all. Placental problems and unexplained stillbirths are also more common in women with prior cesarean incisions. All of these risks of cesarean can be cited in reputable medical journals. Google is your friend 😉

    I’ve now had two wonderful VBAC’s even though the medical community’s making them less common. It’s sad because they aren’t really any less safe overall than having a repeat cesarean for both mom and baby. However, they are far more safe for future pregnancies. I’m considering having a third VBAC, and am VERY thankful I never signed up for all those elective repeat cesareans, since doing so would have considerably increased the risks for both me and my babies. I just wish I could have avoided that first cesarean. If I only knew then what I know now…

  20. August 23, 2007 9:01 pm

    Kathryn – “Google is your friend” – As a medical librarian, I have to put in a plug for medical librarians being your friend as well. 😉
    “If I only knew then what I know now” – I hope to hear less and less of that as time goes by, as more women learn about what is and what isn’t always necessary during birth.

  21. Barbara Stratton permalink
    August 23, 2007 10:05 pm

    For Angela – I’ve never known folks who are against unnecessary cesareans to blame moms wanting convenient due dates or to avoid stretch marks. Rather, birth activists such as myself spend our time trying to convince the media that it is NOT women begging for unnecessary surgery that is driving the cesarean rate in our country higher and higher.

    Also, for a good overview of birth in the old days please see the book BIRTH by Tina Cassidy. What Tina (and many other sources) shows is that

    -women used to give birth to many more children and so the chance of dying in childbirth was multiplied

    -women suffered from malnutrition and so had deformed pelvises that are no longer an issue today

    -when women started moving their births to hospitals the mortality rate actually went UP rather than down. OBs had little training in actual birth and didn’t understand basic concepts like hand washing. Midwives were always better at helping babies get born.

    Also note that although our country’s cesarean rate has skyrocketed, our infant and maternal mortality rates have not improved. Countries with much better mortality rates than the US have much lower cesaran rates and use midwives for the majority of birthing women.

    For Michelle – I support women’s choice in childbirth IF she is informed in making that choice. It is unlikely that OBs are telling women who choose cesarean for no medical reason that you face risks of

    -a higher rate of dying during birth
    -injury to other organs (and boy, if they knick your bowel you are in big trouble)
    -hemorrhage
    -emergency hysterectomy
    -anesthesia mistakes
    -infection
    -post-surgical hernias
    -long term pain
    -adhesions
    -subsequent infertility
    -placental problems in future pregnancies
    -uterine rupture in subsequent pregnancies (whether you labor or not)
    -postpartum depression
    -breastfeeding difficulties
    -bonding difficulties

    Risks to the baby include

    -physician caused prematurity
    -respiratory distress syndrome
    -getting cut – sometimes on the face
    -increased chance of developing childhood asthma

    So, given ALL the facts it is unlikely in my opinion that many women would choose unnecessary surgery.

    For Allison – I’ve never thought of it as moms being “made to feel guilty” about how their birth went. Rather, some women care about how their births go (just like some women really care about how their weddings go and would be devestated if the big day came and the wedding took place without them) and so are hurt when the birth turns into a cesarean. This hurt turns into anger if the woman realizes that the surgery was preventable or unnecessary as was my case. All that pain I went through was unnecessary.

    For Hildy – as this is our second meeting in Blogshpere I sense that you have a very medicalized view of childbirth. Perhaps you are an OB? OBs are trained in pregnancy as an illness and rarely get to see a normal birth take place. I encourage you to become involved in your local (normal) birth community and try to get to witness normal births or at least videos taken of normal births. Obstructed labors/CPD and such are many times caused by the medical management of labor. It starts with forbidding women to eat or drink in labor (the uterus is a large muscle and needs fuel in order to contract), and includes restricting women to bed (hard for the baby to navigate the pelvis when the mom isn’t allowed to move around), as well as unnecessary induction, artificial rupture of membranes, epidurals, and forcing women to push while lying on their backs.

    My cesarean baby was estimated to be in the 95th percentile for size and weight and yet was only 8 lbs 7 ozs at birth. My diagnosis was CPD. I went on the have an unmedicated, 13 hour straigthforward labor with my second child who was born after 14 minutes of pushing and weighed 9 lbs 7 ozs – a full pound larger.

    Guess the ol’ pelvis was perfectly fine after all.

    -Barbara Stratton

  22. August 23, 2007 10:09 pm

    Barbara, thanks for your lengthy comment, good stuff in there.

  23. Julie permalink
    August 23, 2007 10:30 pm

    I have given birth to 3 children, none by c-section. I strongly believe that women should be informed but then the decisions are theirs. I have had several friends have c-sections and their experiences are so much better than mine. With my first child I was in labor for hours without an epidural screaming. Ten years later I still am emotional traumatized. If I say give me an epidural that is my decision and as long as I know the consequences it is my choice. Same thing with c-sections. If a woman chooses to have one that is her choice as long as she is informed of the risks and makes the decision with knowledge.

    I also disagree that hospitals are always places that make people nervous. I felt less nervous in the hospital than at home. With my second child I wanted to go to the hospital so I called my midwife whom told me to stay home and relax in the bathtub for an hour and didn’t take me serious. Then a friend said don’t listen to her, go straight to the hospital!! Well I had my baby 30 minutes after I got to the hospital. If I would of listened to the midwife and stayed home like some some Drs suggest, I would of been having my baby in that bathtub. What a nightmare. Women should trust their instincts and make their own decisions.

    Julie

  24. Hildy permalink
    August 24, 2007 12:02 am

    Rachel: pre-labour diganosis of CPD is notoriously unreliable. However, the article does say “4. In the delivery room, ask questions if your practitioner says you need a C-section”. Intralabour indications for C-section (failure-to-progress, non-reassuring traces) are quite different to size estimates (which are very very very soft).

    I strongly support the right of all women to be adequately informed, and to provide informed consent to procedures they undergo. As for all medical procedures, there are hard and soft indications, there are common and uncommon risks.

    At the end of the day, it’s a judgement call by the woman and the care provider. The woman must be comfortable with the care plan, and the provider must be comfortable with the care plan. I’m not an OB, but I know which things I wouldn’t be comfortable with if the care plan didn’t involve them – adequate anaesthesia, active 3rd stage management, etc. If you can’t agree, if you can’t both sleep well with the care plan, then it’s time to part ways and for the woman to find a new care provider.

    Doctors are risk-adverse, especially for catastrophic outcomes (which are rarely seen by midwives – they’ve been handed over by the time the really awful things happen, usually) that they will remember for the rest of their careers.

  25. Caroline permalink
    August 24, 2007 7:04 am

    I’ve had three c-sections after being diagnosed with placenta previa during my first pregnancy. My placenta ruptured at 34 weeks and my son’s heart rate all but stopped. Were it not for an emergency c, he would not have survived.

    The decision to have two more was done very carefully and thoughtfully with my OB. It wasn’t absolutely necessary the next time around but it just made sense considering the risks. Are there downsides? As with everything in life, sure. But by the second go around I had figured out that getting up and around even before they wanted me to made the recovery literally fly by.

    The woman in your story experienced pain that was unusual and abnormal. I might venture to guess that, as with everything in the news, you picked and profiled someone on the extreme end of the experience spectrum. I am not a psychologist, but I might also venture to guess that her anger and resentment over what happened has only made her recovery longer and more difficult.

    C-section, like it or hate it, is just another way for a child to be born. Try not to have one if you don’t want it. But should it be necessary deal with your feelings and get over it. Dwelling on the past is only going to hurt you and your baby. As any parent knows life changes with the arrival of children and hang-ups over delivery (even one like mine where I almost bled to death and almost lost my child) have to be let go.

  26. August 24, 2007 7:26 am

    “you picked and profiled someone on the extreme end of the experience spectrum” – Caroline, if that’s for me, that’s not deliberately the case at all. As I mentioned, I really hadn’t heard anyone express quite such a sentiment before. Mostly you do hear “a healthy baby is all that matters” so I just wanted to point out that the viewpoint exists. I don’t mean to hold this one woman up as an example for how everyone should feel about birth, I simply wanted to throw that into the conversation.

    Hildy, I see your point, and I’m sure there are some situations where a long discussion is not possible, but I do think it’s important for women to ask questions if there’s time before having an abdominal surgery. I think that’s part of both parties being comfortable with the care plan – I would not be comfortable with a provider who is reluctant to provide information or answer questions. It doesn’t mean I think women should be hostile to *all* of their provider’s suggestions, but simply that there should be proper and honest communication. Also, I’m curious as to why you wouldn’t be comfortable with a birth plan that didn’t include “adequate anesthesia.”

  27. Michael permalink
    August 24, 2007 7:39 am

    How about an article “5 ways to make sure you get a C-section”? Primary elective C-sections are on the rise and the trend looks to continue. I am opposed to unnecessary C-sections but the reality is the rate will not decrease any time soon. First of all, babies actually do better since birth is quite traumatic for babies. Any amount of placental insufficiency will result in hypoxia for the infant. Sure, the vast majority of babies tolerate vaginal birth fine, but we want ZERO complications these days. (solution: no-fault OBGYN insurance). Second, women just don’t like labor and who can blame them. It hurts. Saying that birth is a spiritual experience doesn’t make it hurt less. Labor pain is just so yesterday!

  28. Marie permalink
    August 24, 2007 9:18 am

    Of course, the easiest way to avoid a c-section would be not to get pregnant at all. Much healthier that way, avoids all the mess and expense. Plus, you never have a nine month stretch where you can’t drink pomegranate mojitos. Not to mention enjoying retirement with a full bank account!

  29. August 24, 2007 9:51 am

    Marie, you and Michael are making me laugh this morning. 🙂

  30. Kathryn permalink
    August 24, 2007 10:01 am

    Michael said: “First of all, babies actually do better since birth is quite traumatic for babies.”

    I think you need to do some research on that one. There have been several peer reviewed studies that show babies born via elective cesarean are more likely to have a stay in the NICU than vaginally birthed ones. I don’t define a NICU stay with doing better.

    Instead of just not liking labor and thinking that it can’t be any other way, I’d suggest hiring a labor support professional (doula) who can help the mom during delivery. Instead of having her rely on her husband (who probably knows less than she does about how to cope with childbirth), or having to depend on a busy nurse who at best has two patients at a time to deal with, a doula focus’s just on the mother and gives her the support she needs. She can still ask for anesthesia, but having a doula greatly reduces the chance she’ll even actually ask for it. Most people who hire doula’s report having a better experience with childbirth than those who don’t.

  31. August 24, 2007 10:03 am

    Kathryn, I could be wrong, but I think Michael’s tongue was firmly planted in his cheek. By the way, do you know how far doulas will generally travel? I’m thinking of the rural area where I grew up, and wondering if there are any that serve that area who aren’t an hour or more away.

  32. Lana permalink
    August 24, 2007 10:23 am

    In 1986 I had a c-section. Why? Because my son would not turn. He was going to be born butt first with his legs over his shoulders. If not for that in modern times we both would have died in childbirth. As a result he came out very healthy and so did I. Sure there was discomfort for me afterwards but I healed and never had a problem.

  33. Jonathan permalink
    August 24, 2007 12:04 pm

    Unfortunately this article has the potential to provide fodder for ignorant “all natural maternity” radicals.
    Women have had natural childbirth at home (with a midwife) for thousands of years. And more mothers and children didn’t make it thanks to the lack of skilled *immediate* modern emergency medical care. Things like previa, cord strangulation, breach, skull size vs. mother, severe tearing (especially for mothers with previous emergency c-sections), etc., etc. are just a few of the potentially fatal issues that can come up. OTOH C-sections are major surgical surgical procedures, and along with induction should be discouraged as a convenience since it increases all of the risks associated with any major deeply invasive surgery. Induction should probably never be done with first time mothers over the age of 35 because of the severity and risk of complications (c-sections are safer in this case), and should probably only actually be used in under 30 year old second time mothers who’s babies are late enough to worry their obgyn, and who didn’t previously have a c-section. IOW wait it out unless its an emergency or get a c-section. Most importantly, don’t tell other people what they shouldn’t do when you have not experienced any real complications yourself.

  34. August 24, 2007 12:12 pm

    Jonathan, I’d ask that if you want to call people ignorant you take it elsewhere. I appreciate all comments of varying viewpoints, but do not appreciate name-calling, even if it’s not directed specifically at other commenters.

  35. Kathryn permalink
    August 24, 2007 12:55 pm

    Jonathan, if you’re going to lecture anyone, at least learn to spell. Last I heard, babies don’t “breach” like whales. I believe the proper spelling is breech.

    Rachel, I know of several doulas who do drive quite long distances to assist in childbirth. It’s probably more up to the individual to decide how far is too far, KWIM? You might check out dona.org if you or anyone you know would like the service of a doula. I’ve had one for each of my VBAC’s, and I honestly wouldn’t labor without one. I’ve had OB’s as my birth attendants both times (midwives and CNM’s aren’t allowed to work hospitals where I live), and they are absolutely worth their weight in gold.

  36. Jonathan permalink
    August 24, 2007 4:03 pm

    Rachel, I’m sorry for the appearance of name calling; the intention was summarize and then specifically identify the nature of a knowledge gap. In retrospect I wish I could delete that first sentence.

    Kathryn, Is a typo of a single letter buried within a blog response more interesting than its content?

    For what it’s worth I think that doula’s can be very comforting, but my wife and daughter probably would have died during childbirth without immediate emergency medical intervention. As a result “all natural” one size fits all advice seems worth identifying. After all vaccines, antibiotics, running water, and toilet paper are things people lived without for thousands of years, but that doesn’t make it prudent when you have the choice.

  37. August 24, 2007 6:28 pm

    Jonathan, not a problem, just trying to make sure things stay civil.

  38. Liz permalink
    August 24, 2007 7:33 pm

    Am I wrong or is “cord strangulation” more misconception than truth? I was under the impression that a PINCHED cord cuts of oxygen but a cord that might be perceived as “strangling” the baby is just a result of that baby doing somersaults, etc. in the womb. At every birth I’ve attended (I’m a birth doula), if the cord has been wrapped around the baby’s neck, the midwife or doctor simply unwraps it (a seemingly simple and safe “procedure”). Since the baby is still receiving oxygen through the cord, “strangulation” is not an issue–no air need pass through their throat yet.

    Thanks for any clarification.

  39. Cyndi permalink
    August 24, 2007 8:12 pm

    Here is a link of an article just posted from the Associated Press.

    http://www.msnbc.msn.com/id/20427256/

  40. August 24, 2007 8:16 pm

    Liz,
    I would like to leave the answering of your question to an experienced birth care provider, and I hope one of them who stops by here will offer some insight. From what I’ve read, the cord can be looped around the neck in up to ~20% of deliveries, and while contractions can compress the cord and disrupt blood flow, leading to heart rate decelerations that show on the monitor until the contraction ceases, it reportedly rarely causes a true strangulation and is not a significant cause of fetal complications/death. I’ve also read about the unwrap you mention.
    There was a fairly recent study on the topic that reviewed records and outcomes for this, but I haven’t read it yet. Again, though, I’d like to hear from someone more experienced with actually handling this.

  41. August 24, 2007 8:17 pm

    Thanks, Cyndi – I haven’t really jumped on that story of increased maternal deaths because I’m still pondering it. Wondering to what extent the changes in reporting affected the data.

  42. michael permalink
    August 26, 2007 1:04 pm

    OK, I’m biased. I’m involved with C-sections on a daily basis. The prevailing current medical wisdom is that c-sections are generally safer for babies, but more risky for mothers (the increased risk for the mother is real but very small). If you compare all vaginal birth babies to C-section babies of course there will be a poorer outcome for C-section babies since there is selection bias for problem and pre-term babies. For purely elective c-sections the babies do as well or better than vaginal birth. I am not advocating elective C-sections, merely stating they occur.

    Check: http://www.washingtonpost.com/wp-dyn/content/article/2006/03/29/AR2006032901619.html

    Again, I am opposed to unnecessary C-sections, and I in my opinion a more reasonable c-section rate is about 15%.
    Current rate in the US is way too high: about 30%. This will not change until there is tort reform such as no-fault OB-GYN insurance. Want my opinion what causes high section rates? It’s those damn fetal monitors that get everybody upset, yet have never been shown to improve outcome.

    Quiz:
    1. Which Presidential candidate was an expert in fetal monitoring?
    Answer: Edwards.
    2. What happens if you take a third world country and introduce fetal monitors?
    Answer: The c-section rate immediately jumps! But fetal outcome improves insignificantly.

    I think it is great when women choose fully natural childbirth. But the trend is not in that direction.
    And that is unlikely to change anytime soon.

  43. August 26, 2007 1:12 pm

    “I think it is great when women choose fully natural childbirth. But the trend is not in that direction.” – Michael, any suggestions for how to move in that direction?

  44. Kathryn permalink
    August 26, 2007 4:49 pm

    “For purely elective c-sections the babies do as well or better than vaginal birth.”

    I don’t know if I’d say unequivocally that it’s the same or better. Some studies might argue the opposite: http://www.reuters.com/article/healthNews/idUSCOL87359320070108

    I think at the very least, it’s debatable.

  45. michael permalink
    August 26, 2007 9:36 pm

    “Michael, any suggestions for how to move in that direction?”
    Sure.
    Encourage the use of midwives and other birthing assistants, and push for no-fault insurance for all care providers – OB-GYNs, midwives, etc.

    Point well taken about C-section babies. In general C-sections are safe for babies. It’s hard to say they’re better.
    Also difficult to compare groups since they are not randomized.

  46. August 27, 2007 10:46 pm

    I’m only up to comment #21 but I must say the following merits a mention for clueless and condescending (emphasis mine):

    OBs are trained in pregnancy as an illness and rarely get to see a normal birth take place. I encourage you to become involved in your local (normal) birth community and try to get to witness normal births or at least videos taken of normal births.

    The lowliest of junior residents has hundreds of vaginal deliveries under his/her belt before being allowed anywhere near his/her first C/S.

  47. Hildy permalink
    August 28, 2007 12:24 am

    Kathryn: I read that paper when it came out. It included C-sections from 37 weeks onwards, when there has been previous data which shows much more RDSN in babies delivered by C-section between 37 and 39 weeks (the hospital I trained at had a policy of no C-sections before 39+0 without senior approval). You only have to see one bad case of shoulder dystocia to be terrified of them forever.

    Rachel: any obstetric provider who does not have a plan for analgesia (or who believes that analgesia is not necessary – cue many midwives) is one I refuse to talk to.

  48. August 28, 2007 7:32 am

    Hildy – Gotcha. Read it wrong the first time, thought you were suggesting that everybody must get an epidural.

  49. August 28, 2007 8:40 am

    Ema, I wonder if that commenter didn’t mean normal=vaginal, but normal=not induced, with epidural and extra monitoring and the like.

  50. charlesie edwards permalink
    September 10, 2007 7:47 pm

    I will have a baby with Gastroskisis when he is born.
    Babys with this have the same results either way they are delivered.
    Yet i keep haveing to argue with my docture about delivering vagionally.
    What is your suggestion to do?

  51. September 11, 2007 9:12 am

    Chalesie, I’m not an expert on this particular subject, but could you get a second opinion from another doctor? I’m wondering how much experience your doc has with it.

  52. October 17, 2007 8:46 pm

    “Labor at home until you’re approximately 3 centimeters dilated”

    This sounds great. But how does a layperson with no medical training judge how far her cervix has dilated? Use a mirror and flashlight?

  53. October 20, 2007 9:38 am

    Chloe, I had a rather cheeky answer to your question, so I checked with a midwife/current med student for better advice. She suggests that it’s kind of difficult for lots of folks to check their own dilation, but waiting until contractions are 3-5 minutes apart for an hour to go to the hospital may be a good general guideline. Your mileage may vary, of course.

  54. October 24, 2007 9:29 am

    Rachel,

    I’m 37 weeks pregnant, have hips like a 12 year-old’s and my doctor calmly informed today that I may have a c-section. I’m scared to death. Since I have about three more weeks to go, what else (other than the reasons mentioned above) can you advise me to do to avoid an unwanted c-section.

  55. October 24, 2007 3:35 pm

    Olivia,
    Did your doc say why you might have a c-section? I’d start by clearly talking it over with your doc how you feel about that, what you are willing to tolerate risk-wise, and the like, just to make sure you’re both on the same page and that what your doc is suggesting actually makes sense, is medically indicated, etc. Having someone on hand for support might be really important for you, too.

  56. December 16, 2007 6:54 pm

    For many women, having a c-section is very necessary, however I have to add that there probably are many c-sections that are not necessary and that will always be a great debate.

    If a c-section is necessary for a woman I’m dedicated to helping her get through it and heal the best way possible.

    There are risks for both mom and baby but if you can know all the facts, carefully and intelligently prepare you can save yourself a lot of stress and discomfort.

    My advice is, don’t go 100% on what your doctor says, understand the options, risks and reasons for why things are done and make decisons accordingly.

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