If your intention is to have a vaginal birth, your OB mentioning the possible need for a cesarean can come as quite a shock. There’s a lot to know about why they happen, how they happen, and what it means for your postpartum experience. As April is Cesarean Awareness Month, we thought we’d share some answers to some of the most common cesarean questions, answered by one of New Mom School’s advisory Doctors, Dr. Jeffrey Illeck, MD.
Q: What are the main reasons a woman would need a cesarean?
The most common reason for a first-time mom to have a cesarean is for arrest disorders (ie: she doesn’t get to 10 cm which is called arrest of dilatation, or she is unable to push the baby out which is called arrest of descent. The second most common reason for a first-time mom to have a cesarean is abnormal fetal heart rate tracing or fetal intolerance to labor.
Q: What categorizes a cesarean as “emergency” vs “routine”?
There are a lot of reasons to call for a cesarean, but emergent cesareans are typically due to abnormal fetal heart rate tracing or fetal intolerance to labor. When an emergent cesarean is called, we usually try and get the baby out as soon as possible. There is not an exact time frame, but ACOG guidelines suggest getting the baby out within a half hour. However, if it is truly an emergency, being at a hospital that can do a cesarean quickly is important. With real fetal distress, most of us can get the baby out in less than a minute once mom has adequate anesthesia.
Q: Can a mom have immediate skin-to-skin contact with baby after a cesarean?
At Hoag, we try to establish skin-to-skin ASAP, usually within a few minutes, at the parent’s request. At delivery, we bring the baby over to the isolate to do a quick assessment and if parents want skin-to-skin, the nurses will take the baby right over.
Q: For moms who wanted a vaginal birth but ended up with a cesarean, what factors contribute to being able to have a VBAC (Vaginal Birth After Cesarian) with the next baby?
For a patient to have a VBAC, the incision in the uterus from the prior cesarean should be a low transverse incision. There are very few reasons that a person would not have this type of incision. ACOG has made the statement that essentially all women should be offered the possibility of a VBAC if their hospital has the capability to do it. There are several factors that suggest the possibility of success for a VBAC. These can change as the pregnancy progresses (ie: the size of the baby, the patient’s cervical exam at term, spontaneous labor vs induced labor).
Q: What are the biggest misconceptions about cesareans?
Because it is the most common surgery performed in the United States, and about 1 in 3 births are a cesarean, there is an idea that it is not risky. Complications are rare, but it is still a major surgery. Women who have cesareans have greater risk of infection, hemorrhage, damage to internal organs, and death. And with subsequent cesareans, the risks go up. That is why the safest thing for a mom is to have a VBAC as opposed to a repeat cesarean. That being said, cesareans are also a necessary surgery for many reasons. For the moms who have a cesarean, they should not feel like they failed. Couples put so much time and effort preparing for the delivery they envision, but they should not feel like they failed if they need a cesarean. A healthy baby and maternal safety are the most important outcome and NO mom is a failure if she and her baby are safe.
Q: If you could share advice regarding postpartum recovery to a woman who is scheduled for, or experienced a cesarean, what would it be?
The important thing for moms who have cesareans is to acknowledge that they had surgery and to take it easy. All the layers of the abdomen have been cut through and need to heal. Asking for help is important. Using pain medication, if necessary, is not a problem. Taking stool softener and medication to combat constipation is important. There is usually a fair amount of blood loss so taking iron or iron rich foods is helpful. Taking care of a newborn is overwhelming as it is but having to recover from major surgery makes it harder. Caring for a baby after childbirth is overwhelming and difficult, so listen to your body and ask for help when you need it. We hope the answers to these common cesarean questions were helpful! Be sure to check out more resources on our blog here.