9. Cesarean Series: Part 3 - The Cesarean, The Risks and How to Combat the Rise in Maternal Deaths in America
So, in my previous blog posts, I covered some of the more legitimate reasons for cesareans and the more questionable motives and we’ve finally gotten up to speed on the many reasons obstetricians like to perform these lucrative surgical procedures, which are that they are a convenience to them, a perceived but illogical thought that it’s inherently safer, to avoid the unpredictability of vaginal births and profit motives. Onto the actual cesarean procedure. How is this major abdominal surgery performed?
By now, you’ve probably seen pictures or videos of a cesarean before, or maybe you’ve had one performed on you, as the mother or the baby. The procedure starts with anesthesia. You’ll most likely be given a spinal block in order to numb you from the chest down. This is different from the epidural as it goes just a little deeper into your spinal cord, and is a one-time injection, so you don’t have to be hooked up to a pump to continuously infuse the medication. Once you’re numb and the doctor is ready to start, they will begin by making a horizontal incision near your pubic hairline, going through the skin, fat, fascia, muscle, and finally the uterine wall. They use a curved tool to pry your baby’s head through the small hole. The rest of the body is delivered moments after and the cord is typically immediately clamped and cut. Your baby is then taken to the warmer to suction her nose and airway, and so the nurse can more easily assess for her newborn exam and vitals. After the nurse is done with her assessment, your baby is eventually returned to you. The doctor will manually remove your placenta and sew up each layer of tissue they went through. Most women who have had cesareans stay in the hospital for 3 days to recover. The recovery of the incision made through your abdominal wall will take even longer and you will have restrictions as to how much you can do in your postpartum period.
A “gentle cesarean” is an option that makes the baby’s transition to life outside the womb a little more like a vaginal birth and you can tell your doctor that you would like this to be done. If I chose a cesarean for one of the reasons listed in my last blog, I would demand that these actions be taken, so that my baby had the best possible start. The doctor -or even the mother!- is able to remove the baby slowly from the womb, allowing for that squeezing action that the baby goes through when they travel down through the vaginal canal. This action helps clear the liquid from baby’s lungs, nose, and mouth, so by allowing them to go through the incision more slowly can in a small way replicate this process.
Baby is then immediately put on mom’s chest for skin-to-skin bonding. She can even begin to nurse while she is in the delivery room. The medical team can also assist with vaginal seeding, which inoculates your baby with the microflora that she would have received had she been birthed through the vagina. When the baby travels through the vaginal canal, she receives a ton of good bacteria to help her start her microbiome. Another option to help your baby along would be to leave the cord unclamped. The cord does not have to be clamped immediately. If your baby is put on your chest as she should be in the first place, the cord can be allowed to stop pulsing before it’s cut so that the baby can receive all of her blood.
The risks during and following a significant surgery like c-sections are plentiful. If you are being told by your obstetrician that you “have to” have a c-section, know that no one can force you to undergo surgery. You always have the right to refuse any procedure, including major surgery, at any time. Take these very serious and very real possible side effects of the surgery under advisement, and use this knowledge to make the risk-benefit decision that makes sense for you and your family.
If you’re undergoing a cesarean you may suffer from:
Infection
Blood loss or hemorrhage
Anesthesia complications
Blood clots or VTEs
Complications to future fertility and future pregnancies
Surgical injury
Death
One terrifying possible complication after a cesarean is that there can be serious issues that can occur to your future fertility and your future pregnancies. Pregnancies after a cesarean were associated with an increased risk of miscarriage and stillbirth. You also have an increased risk of developing placenta previa, placenta accreta and having a placental abruption in subsequent pregnancies. This is why I will shout it from the rooftops that you need to avoid a c-section, especially a primary c-section if you can. We are talking about your future children, Mama, and you need to be aware that this baby born via cesarean could be your last.
Other incredibly dangerous risks to the mother include infection at the site which can lead to sepsis or the need for a wound vac if not taken care of properly.
Surgeons are human and there have been many accidental surgical injuries to surrounding organs such as your bladder or intestines and blood vessels due to human error. Blood loss and hemorrhage are huge concerns with c-section surgeries, not only due to the manual extraction of the placenta but also from accidental cuts to veins or arteries.
Ready for the worst part? In just one study, the risk of dying after a cesarean section was 3.6 times higher than that after a vaginal birth. Extrapolate that data out for how many cesareans are performed in the United States and the rest of the world and, voila! You have a very predictable rise in maternal deaths. The complications of anesthesia, puerperal infection, and blood clots, or venous thromboembolisms were the main causes of death among the women in this study.
It isn’t just the mothers that can have adverse side effects. Babies suffer from these surgeries, too. Even though these surgeries are normally done to “save the baby,” there are many complications that can affect your newborn if they are born via cesarean.
One study showed that children who were delivered via c-section have an increased risk of asthma and obesity. Because babies that are delivered via cesarean do not go through that important squeeze through the birth canal, they do tend to have more breathing problems for the first few days after birth. I saw it myself while caring for postpartum mothers on the mother/baby unit at my hospital, and it was very common for c-section babies to breathe faster, sneeze more often or sound congested as they have to work harder to clear that fluid from their lungs.
Many babies delivered via cesarean are scheduled surgeries that can take the baby out of the womb too soon. If they were delivered too early, their lungs may not have enough surfactant to breathe properly and may not be ready for life outside the womb yet. This can lead to NICU admissions if the baby needs more support in order to maintain their oxygen saturation.
Babies can also suffer accidental nicks from the scalpel. Due to the anesthesia which crosses the placenta, the baby can be born with low Apgar scores and fetal distress. C-section babies are 50% more likely to have low Apgars than those born via vaginal births.
Contrary to what your OB would like you to think, these are not riskless surgeries. Many times these risks will vastly outweigh any risk that may or may not happen to the baby during vaginal birth. But that’s the whole point. The risks of BOTH must be laid out for the MOTHER to decide, and that MUST be made clear! CESAREAN SECTIONS ARE A CHOICE TO BE PRESENTED TO THE MOTHER AND MADE BY ONLY HER. These decisions should never be made by a doctor because risks are subjective. One woman may want the risk of a cesarean to avoid any pain from a vaginal birth. That’s HER call. One woman may want the “risk” of a vaginal birth to avoid the risks of a cesarean. THAT’S. HER. CALL. Doctors are not in the business of making choices for patients. They are there to present FACTUAL AND COMPLETE data for both sides of the equation, yet that’s rarely what pregnant women receive.
But just by being here and being fully aware of your rights, YOU have the knowledge you need to make the decision that’s right for YOU and if that’s a c-section, I want you to be PROUD of that.
The fact that the rates of c-sections are absolutely skyrocketing in the United States is a serious concern because of the association with a higher risk of maternal mortality. To address this issue, there needs to be a radical shift in society towards a more holistic approach to childbirth that recognizes the importance of physiological childbirth and the benefits of vaginal birth and home birth.
One of the many benefits of physiological childbirth is that it allows for the natural release of birth hormones that can help to reduce pain, promote relaxation, and facilitate bonding between the mother and baby. As I’ve discussed before, vaginal birth, especially those that occur at home, is associated with a lower risk of complications and a faster recovery time for the mother.
Efforts must also be made to reduce the overreliance on c-sections in situations where vaginal delivery is possible. This may involve promoting the use of alternative interventions such as midwifery, water births, and non-pharmacological pain management techniques. In addition, healthcare providers should be trained to recognize situations where a c-section may not be necessary, and to work with the mother to develop a plan that is tailored to her specific needs and preferences. This is where doctors need to do their part in order to understand how to help mothers who wish to birth breech babies vaginally. Doctors have deskilled themselves in this regard, making them more dangerous as providers to ALL pregnant women who may have an undiagnosed breech baby.
Instead of going into diatribes about the risks of situations that doctors think require cesareans, there needs to be a push to promote education and awareness about the risks associated with c-sections themselves. This may involve providing women with information about the risks and benefits of her different birthing options, and encouraging her to plan her birth according to how SHE sees fit.
The rising rate of c-sections in the United States is a concerning trend that is most certainly contributing to the rising rate of maternal mortality. While c-sections can be lifesaving in certain situations, they are not without risks, and the overreliance on this procedure is leading to unnecessary complications and deaths for too many American women and women around the world. By taking these necessary steps of providing mothers with all of the information on both sides and helping them make informed decisions from a place of empowerment and NOT from a place of fear, we can work towards reducing the rate of maternal mortality and ensuring that all women have access to safe and effective childbirth options.
