Once a Cesarean, Always a Cesarean : The Tides Must Change


As a mother who has had two cesarean
sections, and someone who deeply works in the birth community, the
rising numbers of cesarean sections across the country, as well as
across the state of Connecticut is deeply concerning. Not just as
someone who is educated about this, not just as a mother who hopes to
have more children some day (and not be forced to have unnecessary
surgery), but it is also becoming concerning to maternity care
providers nationwide.

This morning I read an article in one of my favorite parenting magazines, Mothering.
It was about the state of birth in the United States and the lack of
access to real education, information, and providers who will attend a
Vaginal Birth after a Cesarean Section, also better known as VBAC. 
Numerous studies, publications, and scientific evidence have proven
VBAC to be safer than elective repeat cesarean sections, which is
really a no-brainer. Cesarean sections are major abdominal surgery
which any surgery carries risks. There are some cases in which the risk
of the procedure is out weighted by the medical need for the procedure,
but certainly not at the numbers we are seeing them today. Connecticut
currently holds a 34.6% cesarean section birth rate. Meaning when you
step foot inside a hospital to give birth to your child, your risk for
a cesarean birth is 1 out of every 3 women that steps foot in that
hospital, some hospitals in the state have up to 45% cesarean rates
making your risk go up even higher.

In some hospitals across our state, there are something called VBAC
Bans. Hospitals that will simply not accept any woman who is planning
or wanting to have a vaginal birth after a cesarean section. Meaning,
either these women need to travel out of their area, opt for a birth at
home, or consent to a repeat cesarean which they have no desire or need
for.  Why is this all so alarming?   Below is a quote I took from the article about this subject in Mothering Magazine…

In 2002, 26.1 percent of US women gave birth by
cesarean. The majority of these were elective repeat operations and
first cesareans for dystocia, or failure of labor to progress, a highly
variable diagnosis. The cesarean rate is the highest ever for this
country. Eighteen percent of women had a primary cesarean, a rate also
unprecedented.2 Of concern is the fact that young women between the
ages of 18 and 24 have the highest number of first cesareans.3 A
cesarean rate of no more than 15 percent is recommended by the World
Health Organization,4 and a goal of the US National Health Service is a
cesarean rate of 15 percent for first-time mothers by the year 2010.5

What stands out the most is the fact that after studying, running
statistics, surveying, researching, and publishing reports, The World
Health Organizations states for a country of our status, there should
not be a cesarean birth rate over 15% and we are OVER double that
number at this point in time.  Why again is this so concerning? In my
opinion, and again this is just my personal opinion. I am not a Doctor,
I am not a medical professional, I do not work as a medical
professional in any capacity at all. I am simply a mother, who has
extensively researched this, for the health and well being of myself,
and my children.  I do not believe that women are fully being informed
of their risks or even learning how serious this surgery truly is. It
is the most popular surgery among women today, women electing to have
cesarean’s with their first pregnancies, women electing to have major
abdominal surgery for no medical reason in the thousands of elective
repeat cesarean’s that are taking place today. Why? It completely
boggles my mind. As a parent, I can simply not wrap my head around
electing to put myself, and my baby at risk for no valid reason.

Below is another quote taken from the very well written and educational Mothering article.

Dangers for the Mother: Although cesarean section is
safer than ever before, it is still major abdominal surgery with
inherent risks. A woman who has one cesarean will always be at risk for
a uterine rupture in a subsequent pregnancy, whether she labors for a
VBAC or has an elective repeat cesarean delivery.With one prior uterine
scar, the risk of a uterine rupture is 1 in 500, compared to 1 in
10,000 for a woman without a cesarean scar. Each additional cesarean
increases that risk. Postoperative complications include risk of injury
to other organs (2 percent), hemorrhage (1 to 6 percent of women will
need a blood transfusion), blood clots in the legs (0.06 to 2 percent),
pulmonary embolism (0.01 to 2 percent), infection (up to 50 times
higher), and complications from anesthesia. A woman is four times as
likely to have a placenta previa (low-lying placenta) in her next
pregnancy, putting her at risk for miscarriage, bleeding during
pregnancy and labor, placental abruption, and premature delivery. One
birth by cesarean puts a mother at 10 times the risk for placenta
accreta (placenta grows into or through the uterus), for which women
often require a hysterectomy to stop the hemorrhaging. The incidence of
placenta accreta has increased tenfold in the last 50 years.

A US study found that mothers are four times more likely
to die from a cesarean unrelated to health problems, compared with
women who have vaginal births.

These are not small risks, they are not minor complications, and
some of the impacts on the infant can become lifelong issues especially
with the increased risk for breathing
problems in cesarean born infants.  These are not things I am making
up, I simply am not sugar coating them like some women would prefer
that people do. I knew going into the birth of my second child that
having a VBAC was important, not only to me, but to my child, while
that plan did not work out, he got several benefits of  attempting a
VBAC.  One being, he came when he was ready. Had I scheduled a repeat
cesarean, he may have been born prematurely given I had been given two
different due dates. One sooner than the other.  The March of Dimes has
also spoke out against elective cesareans before 39 weeks gestation
because of the great risk for a baby that is simply not ready to join
the world.

One thing that many women neglect to talk about is the emotional
impact of a cesarean section on the mother. In the months after I had
my first child via cesarean I heard a lot of “Just be happy you have a
healthy baby”  of course I am happy that I have a healthy baby, but
that doesn’t change the fact that many women do feel negatively about
their birth experience, and even in some cases they are traumatized.

No, this does not only happen in women who have had surgical
deliveries, but it is so prominent in the cases of cesarean sections
that there is an international organization that aids these women in
their recovery, and offers them an amazing support system for their
recovery, and future births. ICAN also known as The International Cesarean Awareness Network
If there was no need for this group, it would not exist, nor would it
have thousands of members internationally. But people do not want to
really understand that there are negatives of the large number of
cesarean sections taking place today.  Another great quote from the
Mothering Article reads….

Emotional Scars of Cesareans: Personal accounts from
women who have had a cesarean, as well as emerging research, suggest
that despite a healthy baby and a timely physical recovery, some women
experience cesarean birth as a traumatic event. An unanticipated
cesarean is more likely to increase the risk for postpartum depression
and post-traumatic stress disorder (PTSD). As in other traumatic human
experiences, the symptoms of birth-related PTSD may emerge weeks,
months, or years after the event.9–11 Women re-experience the birth and
the emotions associated with it in dreams or thought intrusions. They
avoid places or people that remind them of the event. Some mothers have
difficulty relating to their infants, and some will avoid sexual
contact that may result in pregnancy. They will also exhibit symptoms
of hyperarousal, such as difficulty sleeping or concentrating,
irritability, and an excessive startle response. Untreated
post-traumatic stress often leads to clinical depression.12

A traumatic birth of any kind can leave a woman feeling
disempowered, violated, or betrayed. Unless she has had the opportunity
to process the event, in her next pregnancy a woman who has no way of
controlling what she perceives as events that are likely to reoccur
will sometimes choose to repeat a cesarean with a known physician in a
more controlled environment.

It is comforting today to see the emotional impacts of this surgery,
and the experiences being addressed in such a large scale publication.
In my time working with ICAN and running the chapter here in the state
of Connecticut, I have been contacted by numbers of women who are in
need of a shoulder to cry on, someone who understands when they say
they hated their birth experience, someone to talk to about them not
connecting with their newborn like they feel they should, someone to
just listen. If you think that all these women are ok, you are wrong.

Sure there are thousands that just go on with their lives, and there
are thousands who know their cesarean was medically necessary for one
reason or another, like I experienced with my second cesarean, which I
fully knew was necessary. But believe me, out of the circles of women
you may know, there is at least one that is hurting from her
experience, but is ashamed, scared, or intimidated to share how she
really feels for the fear of the oh so common, “Just be glad you have a
healthy baby” because that is hurtful.

Until you have walked in someone elses shoes, you should always
think twice about what you have to say about their personal experience.
That goes especially to those who have never had children, or had a
cesarean section.

Sorry for being kind of long today.

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