Posts Tagged ‘Cesarean Section’

A Cesarean is Just Easier?

I was at the diner enjoying breakfast and coffee with two of my mommy friends the other day with all three of our babies in tow. As we stood up to leave, a kindly gentleman across the aisle saw our babies and told us that one of his daughters was expecting twins any day. We congratulated him enthusiastically, asked him if they knew the sexes (he didn’t), and asked how his daughter was feeling.

His daughter was tired and uncomfortable, he shared, especially since she had a three year old at home as well.  

“Wow!” we all exclaimed. “She’s going to have her hands full!”

“Yes, she is!” he continued. “She’s going to have a cesarean. Her doctor said it’s just easier with twins, instead of doing it natural.

“Oh?’ I asked, biting my tongue.

“Yeah. I guess with twins one of them could be breech, so it’s easier to do a cesarean.”

After talking a few more minutes, I congratulated him again and told him we hoped everything went well with his daughter’s delivery and that she got some relief soon.  I left with one question burning in my mind:

A cesarean is easier for whom?

It’s certainly easier for the doctor (or at least faster). She calls when she feels contractions, comes in, gets her epidural, and he gets the babies out within a half hour. No waiting around for hours, no concern over a breech baby, no having to sit through two vaginal deliveries.

I’ll even give you that it’s easier for mom at the time, since she doesn’t have to go through hours of labor. But it sure won’t be easier for her during recovery (two newborns and a three year old?!?).  It won’t be easier for her in early bonding times to pick up, nurse, and care for her babies.

It won’t be necessarily be any easier for the babies’ health, and it won’t be easier for them during recovery since mom can’t efficiently tend to their needs.

It won’t be easier for dad, as he will have to  help mom out a lot more during recovery time than he would after a vaginal delivery, since mom will have a much more difficult time getting around.

Now, please don’t get me wrong. If mom needs a cesarean, I think that she should definitely get one and then be prepared with extra postpartum support. Even if she was given the options and all the information, then chose a cesarean, then that would be just fine. At least then it was an informed decision.

But to be told it’s “just easier?” To not give vaginal delivery a chance? To section “just in case” of a breech? To not be told that some OBs will perform vaginal breeches under careful watch? To assume that all twins should be delivered by cesarean?

I didn’t say a word since I didn’t know the whole situation. Perhaps she really does need a cesarean for some other reason, or perhaps this is a completely informed choice. I suppose my rants are only hypothetical. However, I am sure that this situation is not unique, and that there are many women who are not even told that vaginal birth with twins is an option.

Here’s a video on the natural delivery of twins and triplets, for moms who are considering trying for a vaginal birth with multiples. It is inspiring and encouraging to moms of multiples who want to go for a natural birth. I know that not all twins (or triplets) can or should be born vaginally, but I do think it is the doctor’s responsibility to give mom her options and encourage her to choose the best route for her and her babies.

Failure to Progress or Failure to Be Patient?

I was just reading Waiting 2 Hours Can Prevent a Cesarean? from Sheridan over at the Enjoy Birth Blog, and I’m being reminded once again that a little patience in labor can go a long way. Sheridan linked up to a great article about a 2008 UCSF study that showed how waiting an additional 2 hours after “stalled labor” had been diagnosed allowed one-third of women who would have had a c-section to go on to a vaginal delivery! Check out this excerpt from the article:

“While ACOG already recommends waiting at least two hours with adequate contractions in the setting of no progress in active labor, it is routine practice in many clinical settings to proceed with a cesarean for ‘lack of progress’ before those ACOG criteria have been met, according to Aaron Caughey, MD, PhD, an associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, and senior author on the paper.

‘One third of all first-time cesareans are performed due to active-phase arrest during labor, which contributes to approximately 400,000 surgical births per year,’ said Caughey, who is affiliated with the UCSF National Center of Excellence in Women’s Health. ‘In our study, we found that just by being patient, one third of those women could have avoided the more dangerous and costly surgical approach.’ ”

Now, I don’t want to be a redundant blogger, but I think re-sharing the article is worth it because so many women are told they have failed to progress!

I’ve heard it so many times: “After 3 hours, I hadn’t dialated anymore, so I had to go for a c-section…” “After 14 hours of labor, I was only a 5, so we figured we had to just go with the cesarean…” One woman even told me that she had gone backwards in dialation so she needed a cesarean. I’m not sure if that’s even possible, but I think it may have been due to inaccuracy of the nurses’ estimations of dialation (maybe the first nurse said a little bigger, or the second nurse estimated a little smaller).

Another woman I knew “stalled” after her transition period, before pushing. No one had told her that this is actually a fairly normal occurance, and that it should really be viewed as a nice little break for her body. She panicked, thinking her labor was going to take forever, and decided to get an epidural (despite her strong wishes for a natural birth). She went on to a vaginal delivery, but felt very disappointed over her labor and birth experience.

Stalled or slow labor is normal. As long as mom and baby are doing fine, using natural means to progress labor (Check out Sheridan’s post for more links on this topic) and having a little patience can make a big difference for many moms. Of course, for some, a cesarean is necessary for true lack of progress, and no mom should  be made to feel at fault if she had one in any case. I just think that those doctors who are hasty should perhaps slow down a bit, follow their own ACOG guidelines, and wait to see if mom progresses before making the cut.