11-Let's Talk About C-sections

Transcript:

Episode 11 –.

Welcome to the Preparing for Childbirth podcast where we'll talk about God's amazing design for childbirth, learn how to prepare for the unknown, handle the pain and lean into God's character through it all! I'm your host, Jenny Childs. I’m a follower of Jesus, wife, mom, and lover of all things childbirth. Thanks so much for joining me today!

This is episode 11.

I recently learned that April is Cesarean Awareness Month so I thought I’d take the opportunity on my podcast to talk about this potentially lifesaving operation and ways to reduce preventable c-sections. I’ll also talk about some options you have if you do find yourself needing to head to the OR during childbirth, what to expect during the time of recovery and options for future pregnancies.

According to an article published by the World Health Organization in 2021, cesarean sections now account for more than 1 in 5 of all childbirths worldwide – around 21%. Obviously, that rate varies from country to country. In the USA the statistic is 32.1% of all births in 2021. That’s almost 1 in 3! I was unable to find any current statistics for Nairobi, Kenya where I know I have a number of listeners. The same article from the WHO indicates that the numbers are likely to continue to rise over the coming years. And this is concerning.

Researchers estimate that almost half of the C-sections performed in the US are done in situations when babies could be safely delivered vaginally instead. Preventable C-sections may be responsible for up to 20,000 major surgical complications a year, including everything from sepsis to hemorrhage to organ injury.

Let me read this quote from the article, “While a caesarean section can be an essential and lifesaving surgery, it can put women and babies at unnecessary risk of short- and long-term health problems if performed when there is not medical need.” So that raises the question, What constitutes a medical need?

According to the International Cesarean Awareness Network, some obstetrical emergencies that lead to a C-section include:

-prolapsed cord (where the cord comes down before the baby)
-placental abruption (where the placenta separates before the birth)
-placenta previa (where the placenta partially or completely covers the cervix)
-placenta accreta (where the placenta is too deeply embedded in the uterine wall and has potential for maternal hemorrhage)
-eclampsia/pre-eclampsia (pregnancy-induced high blood pressure, causes severe swelling due to water retention, and can impair kidney and liver function.)

In these cases and others, cesareans can be life-saving and necessary.

There are some other reasons that doctors recommend a c-section that could potentially be handled another way. Some of those include:

-fetal malpresentation such as transverse lie or breech – that means the baby is lying sideways in the uterus or in the case of breech, baby is presenting feet or buttocks first. (A vaginal breech birth could be an option if a skilled provider is available – unfortunately that is rare - or a technique called external cephalic version could be used to turn a malpositioned baby prior to delivery.) I actually had the privilege of going with a friend to have a version done a number of years ago. It was kind of crazy watching the doctor with his hands on mama’s belly gently but firmly push the baby around into a head down position. Thankfully that little one stayed put with her head down after that until mama went into labor a week or so later and after a few prodromal starts and stops, she had a beautiful vaginal delivery.

There are also times when mama has been laboring normally then the doctor becomes aware that the baby is presenting brow or face first, this is a time when a c-section can save the day.

Another reason often given for suggesting a c-section is

-suspected cephalopelvic disproportion aka CPD – (meaning that the head is too large to fit through the pelvis or the pelvis is considered too small. The actual condition is very rare. This is often over diagnosed, and many women do go on to have vaginal births after a cesarean for CPD)

Other reasons given include

-Maternal medical conditions and

-fetal distress. On their website, the International Cesarean Awareness Network says this about fetal distress, “This is a hot topic with the recent studies indicating that continuous electronic fetal monitoring increases the cesarean rate and does not show a relative increase in better outcomes. Discuss with your care provider how they define fetal distress and what steps are used to remedy the situation before a cesarean.”

Please note, that I have not given a comprehensive list here.

In light of that quote that I just read, let’s talk for a minute about potential risk factors and what you can do to minimize the risks.

In the case of external fetal monitoring, you could ask for intermittent monitoring with a doppler device or electronic monitor. The external monitors tend to keep you confined to bed and being able to get up, move around and work with your body and gravity to help move your baby down through the pelvis and into the birth canal is a great way to help reduce the risk of needing a cesarean.

Slow or no progress during labor is also a big risk factor. Having continuous support during your labor can be so helpful to minimize this risk. Having a doula, your husband, &/or someone else to help you keep moving and try different positions and to encourage you and help you stay in the right frame of mind is invaluable. Delaying or avoiding an epidural can also help minimize the risk of slow or no progress. And during the pushing stage, using upright positions works with gravity to help bring your baby out.

All that being said, there are still times when a cesarean section is needed. How do you know if it’s the right decision for your situation? I would encourage you to use the BRAIN acronym I’ve mentioned before on the podcast to help you ask good questions and be a part of the decision making process. Rarely is the need for a cesarean a true emergency where things are moving so fast there’s no time for questions. If that’s the case, it will be obvious to everyone involved and you will be thankful your doctors are moving fast. Usually, there is some time to ask about Benefits, Risks and Alternatives (that’s the B-R-A of BRAIN), There’s time to pause and pray, then along with your partner, use your Intuition (that’s the I)to make a decision, and the N stands for Now or Never – meaning you might decide to ask for more time before you have to make a final decision. I’ll put a link in the show notes to a graphic to show you what I’m talking about. Hopefully, asking good questions allows you and your care provider to get on the same page and helps you make an informed decision that’s in the best interest of you and your baby.

I recently heard from a Kenyan friend who had gone through my childbirth classes. Her water broke early – at 36 weeks and she and her husband were faced with some moments of uncertainty and unexpected questions to answer. This is the message I received from her after it was all over,

“Thankful to God for a safe delivery. It did not go as planned at all but God lead and directed our paths.

I delivered via CS. The classes were super helpful in enabling us to make an informed decision.

But Psalm 23 was extremely helpful as well. I sang Bwana ni mchunganji wangu throughout the surgery.”

For my American listeners, the song she refers to there means “The Lord is my Shepherd” and it’s a beautiful musical version of Psalm 23. I’ll add a link in the show notes if you want to listen to it on youtube.

God is indeed the good shepherd and he can be trusted whether you are walking through green pastures or through the valley of the shadow of death. – whether everything goes to plan in your birth or you end up on the operating table.

If you do find yourself in need of a cesarean, I encourage you to look first to the Lord for strength and guidance. I also want to take the next few minutes to talk a little bit about what to expect:

If you don’t already have one, you’ll need an IV and a catheter will be inserted to collect urine. You will be connected to monitors to watch your heart rate and blood pressure. You’ll be given anesthesia, often in the form of an epidural, which will numb you from just below your breasts down. Then your abdomen will get an anti-bacterial wash and your pubic hair may be partially shaved. Next comes the skin incision, then the muscles will be pulled out of the way and the uterus will be cut open, then the amniotic sac. Now the baby can be disengaged from the pelvis if necessary and born through the opening in your abdomen. Because of the anesthesia you don’t feel any pain during all this but you will likely feel some tugging and pulling sensations. After baby is born the cord is clamped and cut and baby is evaluated to be sure everything is okay. The placenta is removed and the uterus repaired, muscles put back in place and the skin sewn up. The baby is generally born pretty quickly but it takes a while (maybe 30-40 minutes) for the rest of the operation to be completed. There will likely be a drape hanging so that you can’t see what’s going on.

Some hospitals don’t allow a support person in the operating room with mama. Many of my friends in Nairobi have said that was their experience. Other hospitals offer family centered cesareans meaning that they involve the family as much as possible – Dad and/or another support person is allowed to be with you in the operating room, they are allowed to watch through a clear drape or via mirrors if that’s desired, and baby is brought to mama as soon as possible if baby doesn’t need immediate medical attention. It is even possible in some hospitals for mama and baby to be skin to skin and initiate nursing while the operation is being completed. My sister was able to have her husband with her and baby was swaddled and brought to her right away but she wasn’t able to be skin to skin or initiate nursing until she was in the recovery room.

You can talk to your doctor ahead of time to learn what the policy is in the hospital where you’re planning to give birth and to advocate for a more family friendly atmosphere if needed.

As I’ve talked to friends who have had c-sections, the recovery is the thing they say to warn people about. You’ve just had major surgery and given birth to a baby. Immediately after the birth, it takes some time for the anesthesia to wear off and for you to regain complete feeling in your body. In the process some people have mentioned shivering or experiencing chills and high-blood pressure but that’s not everyone’s experience. As with any surgery there will be pain in the aftermath. You’ll be given medicine to manage it. It’s a good idea to take it as prescribed to keep the pain under control. If you’re concerned about breastfeeding, just talk to your doctor. They can make sure you have the right kind of painkiller to help you and not hurt the baby.

In the long run, the recovery is going to take time. And you will need help. Let your community rally around you to help with providing meals and doing some cleaning as needed. Generally, it’s ok to lift your baby but nothing heavier. Follow your doctor’s instructions for caring for your wound. It’s in an awkward place for holding and nursing a baby but using pillows to prop baby up so that she rests above the wound will help. You can also try using the football hold and nursing baby from the side. My friend, Joy, the pelvic floor therapist who joined us on the podcast last month said, “tell them about scar massage.” I knew nothing about scar massage so, I’ve been learning… I don’t have time to go into a lot of detail here but I will share a few things. You can start massaging your scar after you get the ok from your doctor that everything is well healed – that’s usually around your 6-week checkup. Why is scar massage beneficial? It increases the blood flow which is beneficial for the continued healing process and massage also helps the scar tissue learn where to lie down and keeps it from growing in unwanted places like on the surrounding organs. When scar tissue grows onto the surrounding organs it can cause problems like low back pain, frequent urination, or pelvic pain and pain with intercourse. I’m not going to try to tell you how to go about massaging a c-section scar but there are lots of good resources online where you can learn for yourself.

Remember that having a cesarean section is major surgery and it just takes longer to heal from that. It’s ok! Be patient. If you’re listening to this and you know someone who just had a CS, reach out and offer to bring a meal over, even if it’s been over a month since the baby was born. Some people say they’re feeling better after about six weeks, for others, the healing process takes longer.

There’s one more thing I want to touch on – the question of future pregnancies and births. Some people think that once they’ve had a c-section, that’s the only option open to them for future pregnancies. That is not necessarily true. Vaginal birth after a cesarean (also known as VBAC) can be a valid option.

As I’ve been researching to put together this podcast, I’ve come across a lot of information and It feels like too much to tack on to the end of this episode, especially when we’ve covered so much already today. I think we’ll just hold that conversation until next time. So I’ll meet you back here in two weeks time to talk all about VBAC.

If you’ve enjoyed today’s podcast or found it helpful, I hope you’ll share it with a friend, and I’d love for you to leave a rating and review.

It is my prayer that these podcasts will help you grow in confidence and peace as the day draws near for you to meet your little one. I'm so glad you tuned in today as you are Preparing for Childbirth.

Show notes:

April is Cesarean Awareness Month. Statistics indicate that cesarean sections account for more than 1 in 5 of all childbirths worldwide. In this episode we talk about reasons you might need a cesarean, ways to reduce preventable c-sections, how to determine which is which, what to do if you do find yourself needing to head to the OR during childbirth and what to expect during the time of recovery.

Links mentioned in this episode:

B.R.A.I.N.

Bwana Ni Mchunganji Wangu

Resources used to prepare this episode:

International Cesarean Awareness Network. (2020, January 14). FAQs about Cesareans - International Cesarean Awareness Network. International Cesarean Awareness Network - Education, Support, & Advocacy for Birth Justice & Healing. https://www.ican-online.org/faqs-about-cesareans/

World Health Organization: WHO. (2021, June 16). Caesarean section rates continue to rise, amid growing inequalities in access. who.int. https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access