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5 Truths About (Unplanned) C-Sections

Posted by Lara Salahi  June 10, 2013 09:38 AM

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Taking a childbirth class was probably one of the best decisions I made during my pregnancy.

It allowed three hours a week of undistracted time to communicate our labor and birth plan.

And -- thank goodness -- it shot down my husband’s idea of shoving me in the back of his police cruiser and, sirens on, speed his way to the hospital -- all before ferociously wheeling me through the maternity ward like Julianne Moore in the movie “Nine Months.”

(Oh, Hollywood…)

But, while I spoke highly about childbirth classes to expectant mothers asking for advice on the best thing they can do to include their partner in the journey, I have a confession to make: I wasn’t always paying attention in class.

Like that whole hour on cesarean, or C-sections. Besides being shown a scalpel, I can’t tell you much else.

I didn’t think I would need to know about that method. That is until, 18-plus hours of labor later, my delivery doctor mentioned it as an option and asked me what I thought.

What I thought?

There’s something about entering the second stage of labor and having to make an informed decision that doesn’t quite mix.

I had questions about the options she laid out, specifically about c-sections. Questions that cleared and blurred between contractions. Questions I wish I had answers to before entering H-hour(s).

Here are a few thoughts I remember that came to mind then, and some truths about C-sections (a.k.a the Cliff Notes version of that hour-long part of class I overlooked).

I need to make a decision right away

Maybe not. There’s a difference between unplanned and emergency c-sections. An emergency c-section happens when for some reason the health of the mother or the baby are at immediate risk. An unplanned one typically happens when the labor gets off track, but there’s no urgency, says Dr. Toni Golen, medical director of labor and delivery at Beth Israel Deaconess Medical Center.

“A common reason is the labor may not be progressing. That’s something where it’s unplanned but not necessarily an emergency,” she said.

In many cases of unplanned c-sections, there’s no absolute time limit to make that decision, said Golen.

“If mom and baby look well then there’s no imminent reason to rush it,” she said.

So breathe. And, if it makes you more comfortable, ask for the medical staff to step out while you discuss your options with your support person(s).

If I say no to a c-section, I’ll be putting my baby at risk

A c-section was one of many options that was presented to me when it seemed like my labor stopped progressing. And that’s exactly what it was: an option. So saying no was just as acceptable as saying yes. In fact, according to Dr. William Camann, director of obstetric anesthesiology at Brigham and Women’s Hospital, one of the most common questions a woman asks when something unexpected happens during labor is if there’s anything she can do differently to get things back on track.

In many cases, there are.

If a woman has not had an epidural, sometimes changing positions or even getting up and moving around may be able to change the labor situation, said Camann. Also, getting an epidural may help change labor as well, he said. It can help relax the muscles and give a woman some much needed rest before she picks up her second wind.

“They can take a nap and sometimes the cervix dilates and they’re ready to deliver,” said Camann. “If you wait, maybe you might progress.”

“We do try to focus on women feeling at that moment that they’ve done everything they can do and feel comfortable moving forward,” whatever that entails, said Golen.

Just make sure to have that very honest conversation with your doctor about where you stand in your labor and delivery and what your options are.

Having a c-section puts a limit on the number of children a woman can have

Not necessarily. Of course, multiple cesarean deliveries bring its own set of risks, but there is no limit that is put on mothers for the number of babies she can have.

Among those risks is a higher chance that the placenta will attach to the uterus in a way that makes it difficult to remove after the baby’s birth, according to Golen.

“The greater the number of cesarean deliveries a woman has had, the greater her risk just because she has had a surgery,” said Golen, adding that for some women, it may be due to scar tissue buildup from the incision.

“Some who’ve had 4 or 5 c-sections should think about the risk,” said Camann. “It doesn’t mean that you can’t do it, but there should be increased vigilance.”

Once a woman has a c-section, she’ll always have a c-section

Nope. In fact, depending on the reason for having a c-section, many women are encouraged to have a vaginal delivery the next time around. It all depends on why you had a c-section in the first place as well as your health and the health of the baby during the next pregnancy.

I will miss out on the most important first minutes of my baby’s life

Any childbirth expert will tell you about how important those first few minutes of a baby’s life are -- the benefits of skin-to-skin contact to regulate the baby's body temperature, and how important it is that they latch on to breast feed as soon as possible.

C-sections are done using a regional anesthesia. Typically, no sedatives are used. That means, while a woman can’t feel much except for some tugging and pressure, she is wide awake.

Many times, depending on the reason for the c-section, a woman is still able to engage her baby just as she would during a vaginal delivery. In fact, Brigham and Women’s Hospital is just one of many places that have taken part in a movement called the “family-centered cesarean,” says Camann.

For example, the monitors placed on the mother’s chest are moved to her side so the baby can be placed on the bare chest. And other monitors are all placed on one arm so the mother has one arm free to interact with her baby.

“We’ve had instances where the baby has gotten on the dad’s skin, so the baby can get the benefits and it becomes a good way for fathers to bond,” he said.

Another option for a family-centered cesarean? A clear surgical drape divider so the mother can see the delivery.

“We also try to keep the level of conversation down and centered on the woman,” he said.

Bottom Line: Talk talk talk. Ask ask ask. Labor is unpredictable. That’s why it’s so important to communicate your desires to your labor support team (your partner, your mother, etc.) before go-time. It’s even more important to have an honest talk with your delivery doctor about the most reasonable and safest option for you.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

Lara Salahi is an award-winning multimedia journalist whose specialty is reporting health and medical stories. She has worked in local, network, and cable television, international print, and documentary film. She More »

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