8. Cesarean Series: Part 2 - When Are Cesarean Sections Necessary?
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I know I’ve talked a LOT about the surplus of unnecessary cesarean sections, and I stand by my stance that entirely too many are performed these days, on American women especially. This is a surgery that is often used to get a birth over quickly, make that doctor and hospital a bunch of money, and cover their ass by saying “We did all we could.” But I am fully aware that there are situations wherein if this were a different time or a different place and this medical procedure wasn’t available, the mother and/or baby could die.
There are times when a cesarean is going to be the safest way for you to birth your baby, and you should feel absolutely zero shame in that. Many women who have planned for physiological births have been dealt a devastating blow when they’ve been diagnosed with an issue that turns their birth plan on its head. If a c-section is the furthest thing from your dream birth and you find yourself mourning that perfect birth that you’ve been going over in your head for months, it's okay to be upset. You can grieve over what you are losing, but don’t get so caught up that you lose your focus.
Your baby still has to be born and you want that day to still be a beautiful and joyful event, so after you get all of your tears out, it’s time to start changing your headspace. We have control over and can shift our mindset, so begin to do that work. You can choose to be grateful that we have this amazing ability to save the two of you. That should be your focus from now on. That you aren’t going to be a case where the woman and baby died in childbirth. You’re going to survive because of modern-day science and that is a beautiful thing.
Opinions may vary on which situations require a c-section. Still, I’m going to go over some of the scenarios in which I, super crunchy, anti-hospital birth Katie, would more than happily schedule a cesarean section to birth my baby.
If my baby’s cord had prolapsed and it could not be resolved with positional changes, cut me open, doc, and save my baby. There would be little room for discussion in this situation. Events like these happen fast and need to be resolved fast. It’s always beneficial to go over scenarios like this in your head in order to prepare, even if your pregnancy is going swimmingly and you have no other issues. Cord prolapse can happen naturally, but is often a side effect of AROM or artificial rupture of membranes, so the best way to avoid this situation is to say NO to your doctor breaking your bag of waters. That being said, sometimes it just happens.
When genital herpes, or the Herpes Simplex 2 infection is active and the baby goes through the vaginal canal, the baby can come in contact with the virus and become infected and this virus can and has killed babies. This is why we don’t allow anyone to kiss our babies because Herpes Simplex 1, or the cold sore virus can do the same thing. If I had genital herpes and had an active infection with lesions, I would absolutely have a cesarean. It just wouldn’t be worth the risk to me.
HIV diagnosis used to be an automatic c-section, but now it’s understood that if your viral load is low, your baby should be okay to come in contact with your blood and cervical mucus. HIV-positive mothers also have weakened immune systems making them more susceptible to infection after this major abdominal surgery, but this is a situation in which nuance is involved and would be a possible cesarean section for me.
Placenta previa occurs when the placenta covers the cervix which can cause hemorrhaging and obviously blocks the outlet of the womb. This would be another easy “yes” for me. There really is no way to naturally birth your baby with placenta previa. One thing I do want to mention is that if you choose to have ultrasounds during your pregnancy, at the 20-week ultrasound, many times you could be diagnosed with a “low lying placenta.” Do not let this freak you out. Most times, as your uterus continues to grow with your baby, your placenta will naturally move further up, so don’t let them scare you with that nonsense. Some risk factors that may increase your chances of having placenta previa are if you’ve had a baby, if you’ve had previous uterine surgeries, and if you’re carrying multiples. Being over 35, smoking, and using crack are also risk factors, so if you could be so kind, stop smoking crack right now. And stop being over 35. That would be great.
When the placenta attaches too deeply into the uterine wall, making it difficult for the placenta to detach, this is called placenta accreta. Your risk for this complication increases after previous uterine surgeries, including previous cesareans, if you have placenta previa, if you are over 35 and it increases slightly after each pregnancy. A quick reminder that even if you have some of these risk factors, the chances of this happening are still remote. Because the placenta is so deeply implanted into the uterine lining, often times a hysterectomy accompanies the cesarean surgery.
You probably know already that many twins are birthed via c-section, but I have seen so many beautiful videos of twin home births. Twins and multiples require a conversation certainly around what is appropriate under which circumstances. Dichorionic Diamniotic (DCDA) twins are very likely able to be birthed vaginally. These twins have separate placentas and separate sacs. When you get into Monochorionic Diamniotic (MCDA) twins which have one placenta, but two amniotic sacs, and Monochorionic Monoamniotic (MCMA) twins which share a placenta and an amniotic sac, it is certainly necessary to discuss having a cesarean. If twin A is born and then the placenta is birthed before twin B is out, that can be dangerous for that second baby. Pregnancies with 3 or more babies are almost always birthed with a cesarean section surgery. There are a lot of factors to play in those pregnancies and if I were having more than two, I would most likely find myself happily in the operating room.
If you have diabetes and have uncontrolled blood sugars, this can make your baby gain more weight due to the excess sugar in your shared bloodstream. If I was unable to control my sugars during my pregnancy, I might be more reliant on those ultrasounds that can be wildly inaccurate in terms of weight, but it’s important you have at least an idea of what’s going on in terms of size. Babies can become stuck in the pelvis if they’re hooked up to a literal stream of sugar during your pregnancy. These bigger babies can have a problem figuring their way out of the pelvis especially if you’re birthing in a hospital setting and your movement is restricted, which doesn’t allow the pelvis to open as it would in a physiological birth. The problem of big babies in a gestational, type 1 or type 2 diabetic undergirds the importance of taking the best care of yourself, and in turn your baby, during your pregnancy with a high protein and balanced diet. I highly recommend Real Food for Pregnancy by Lily Nichols to help you figure out your pregnancy nutrition. This book is absolutely fantastic and I recommend it to ALL pregnant women.
Do you think there are other reasons for necessary c-sections? Let me know! DM me on Instagram and let’s talk about it! I love hearing different points of view!
As always, this is NEVER meant to be taken as medical advise. Always consult your conscience when making big decisions about your pregnancy and birth!
