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Once a Cesarean, Always a Cesarean : The Tides Should 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 healthy-baby-applebreathing 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.

Danielle Elwood

8 Responses

  1. Thank you for your article.
    I’ve had two sections.
    The first after 31 hours of labor, posterior forhead presentation, diagnosed as failure of descent. Which, I believe, may truly have been the case (my midwife tried, and I tried, and tried, and tried with positioning and internal manipulation to turn her, but she wouldn’t descend). My second was a premergent C due to placenta failure and oligohydramnios (less than 2 after several days of monitoring) at 36 weeks.
    Both were planned vaginal births, intended to be natural, midwife, doula, etc. etc…. yet both ended in c-sections.
    I feel comfortable with the outcome, and grateful that medical intervention was available, and yet, there’s always the nagging what if’s.
    The current c-section numbers are outrageous; and I just don’t believe its because babies are getting too big for mamas pelvises.
    There has to be greater awareness of the very real dangers of c-sections and mothers have to truly know and understand the risks before consenting. And by consenting, I don’t mean, here sign this in the middle of labor. The risks of interventions and c-sections should be fully disclosed & discussed well ahead of baby’s birthday.

    Thank you for bringing more info to the table.


    …The apple photograph gave me shivers. Goosebumps. Even the second time I looked at it.

  2. elwood says:

    Thank you for your comment Shannel, you have proved my point of the entire article. I know that you may not have read it, but the article you replied to was about promoting VBAC!

  3. Shannel says:

    i just wanted tosay that the headline once a c-section always one…uhh uhh not true speaking from experience i a mother of four…i had thre c-sections one 2003 one in 2005 an one in 2006 my daughter today is 9 months an she was a vaginal natural birth…….
    she was born May 26th 2009 an it took 15 min for her to come out..i am very grateful an very blessed just wanted to say that… I am in very good health an have not had an complications so far…there is a god i can tell u that..

  4. Tammy says:

    I have had 5 successful VBACs. Even with my success, I am still finding it hard to find a care provider to assist with my future births.
    What a sad sad world we live in. We can freely choose how to end a pregnancy but we are stripped of our rights when it comes to delivery.

  5. elwood says:

    Thank you for sharing your experience Jessica. I was happy to share in your journey through your second pregnancy. :)

  6. Jessica says:

    I think this is a good article…I had an emergency section with my first and it went fine, i healed fine etc…with my second i figured the section was so easy might as well do it again! and i did, again it was easy(for me). not everyone has my experiences, but for me, they were both easy. with my third i decided i wanted a natural delivery. I saw the high risk MFM for my pregnancy because of my 2 previous premature deliveries. They were so beyond against it!!!!! BUT, i stuck to my guns and stood my ground, and i signed everything AMA to have a vba2c! things didnt go as planned though, because when my water broke because she was small(what they say) she had gone from head down to her elbow comming out of my cervix..and off for the emergency section i went. :( i had my tubes tied because i know more than 3 sections is too great of risk to my health but to this day i am really upset about the whole thing and think of what could have been done differently….

  7. elwood says:

    Thank you for sharing your experience. It is stories like yours that really echo how we are not advancing in the medical community, but we truly are taking steps back.

  8. Jupiter says:

    It’s amazing to me how quickly the attitudes about VBAC changed from just a decade ago. My fist child was a HORRIBLE c-section (it really was a medical rape). That was 19 years ago. 13 years ago,I was pregnant w/ twins. My OB approached VBAC as being the safest option and the attitude was, “Well,OF COURSE you’ll have a VBAC”. I went into labor 5 weeks early and my dr was out of town. The doctor who attended to me was a nationally renowned expert on multiple births. Again, never questioned a VBAC. Now, women are aghast when i tell them I had a VBAC with TWINS. That’s automatically a c-section,it seems.

    8 years ago, my dr was again wonderful about encouraging VBAC but the hospital I birthed in was not and 4 years later, the same hospital instituted the VBAC BAN.

    Unfortunately, the VBAC resistance has spread to the midwifery community and I could not find anyone who would attend a VBAC homebirth. I refused to have another c-section, especially knowing I can successfully have a VBAC. We opted for an Unassisted Homebirth. It turned out wonderfully but since then, I receive emails & phone calls from women who feel that they have no choice but to have an UC at home. It’s very concerning…birth options are being limited so women are taken birth into their own hands and in some of these cases, it might not be the safest option.

    sorry for rambling ;-/