Cesarean Awareness Month: Realities of Cesarean Birth in Maryland
April is Cesarean Awareness Month, and considering that 1 in 3 babies are currently born via Cesarean in the United States, it’s important to understand what exactly this means for families experiencing surgical birth. Cesarean births, planned or unplanned, bring emotional and physical challenges for families as they recover from their experience, and can also impact their approach to future birth experiences. Discovering the implications of these birthing environments and scenarios can help families prepare for birth, and also know their options when planning a birth after a Cesarean.
What Reasons Validate Cesarean Birth?
While there are many factors that contribute to the decision by a care provider to recommend cesarean as the safest for both mother and baby, the following is a list from ACOG (the American College of Obstetrics and Gynecology) of reasons for a cesarean:
prolapsed cord
placental abruption
placenta previa
fetal malrepresentation (such as breech, a transverse lie, or other presenting feature)
cephalopelvic disproportion (baby’s head is too large to fit through the pelvis)
medical conditions with Mom
fetal distress
It is important to discuss with a health care provider the assessment leading to the above conditions if questions arise during the birth process to understand fully their implications for childbirth.
What are Cesarean Rates of My Hospital?
Maryland’s hospitals list their cesarean rates yearly and can be found here, as reported by the Maryland Health Care Commission.
How is Cesarean Recovery Different?
Given the differences in each woman’s health, fitness/age and more factors when they have a cesarean, recovery experiences vary from person to person. That being said, many symptoms that coincide with abdominal surgery are common; issues with gas, pain at the sight of incision, as well as the unexpected presence of uterine contractions as the uterus shrinks back to its normal size. Major fatigue is common as well, especially if cesarean birth occurred after laboring, plus the rigors of attending to a newborn while in recovery.
When Can I Exercise?
Combating the fatigue and getting out of bed is encouraged after a cesarean to help aid recovery as soon as possible, but don’t overdo it! Most are advised not to lift anything heavier than their infant, and to try and keep baby at a level where bending down to lift is avoided. Going up and down the stairs should be done in a limited fashion. Driving is discouraged for up to 2 weeks to avoid tightening the abdominal muscles when braking suddenly. Moms should focus on allowing their body to heal, staying on the couch or bed with baby and gaining assistance with housework, cooking and tending to baby.
As each woman is different, some feel encouraged to seek clearance to work out by their 6 week visit, and many times will feel well enough to do so. Whatever your comfort level, stay in tune with your body and listen to what it is telling you; start resuming normal activity slowly and increase as you feel able.
What If I Want To Attempt Labor Again?
For many, the unexpected nature of cesarean birth, and emotional and physical tolls of the experience lead them to seek resources for having a vaginal birth with a subsequent pregnancy. Many providers refer to this as a TOLAC (trial of labor after cesarean). Usually, a provider will assess the previous labor and cesarean situation to determine whether the mother is a good candidate for a TOLAC. Many women who wish to labor desire to use the term that is given to women when they achieve a vaginal birth experience, which is VBAC (vaginal birth after cesarean). For those women, the phrase TOLAC implies skepticism about their body’s ability to birth their baby vaginally, and the goal of a VBAC is inspiring to them.
How Do I Know If I’m A Good Candidate?
While each provider has their own practice and recommendations, ACOG has created an evidence based list of criteria to consider when mothers would like to labor after a cesarean:
-low-transverse uterine incision
-clinically adequate pelvis
-no additional uterine scarring or previous uterine rupture
-on-call physician support for close monitoring of baby and assessing need for a cesarean delivery
What Are the Risks of Labor After Cesarean?
The most commonly discussed concern when preparing to labor is the risk of uterine rupture from previous scarring to the walls of the uterus after the previous cesarean. While this is a serious situation, rupture happens in less than 1% of VBAC attempts.
What If I Don’t Go Into Labor On My Own?
Most providers will not induce a woman laboring after a cesarean. Many times the risk of uterine rupture increases with the medications and methods necessary for an induction, as well as increasing the risk for a repeat cesarean. Be sure to discuss with your provider, as well as review your labor experience from your previous birth, to weigh all options carefully.
I’ve Had 2 Cesareans, Can I Still Try For A VBAC?
There are many successful VBACs that occur after more than one cesarean. This provides much hope and inspiration to women who felt the need to schedule a repeat cesarean and want to attempt labor with a later pregnancy. Be sure to discuss with your provider their comfort and support of your wish to VBAC.
Where Can I Connect With Others Who Have Experienced Cesarean Birth?
There are many amazing support networks available to women who are processing their experience during their cesarean and recovery. Maryland is proud to boast several ICAN (International Cesearean Awareness Network) chapters that hold regular support meetings, provide information to families attempting labor after a cesarean, and advocate for changes in policy to allow VBAC options to more women, and prevent factors that lead to cesarean birth. Many of the ICAN chapters also have Facebook groups. Speaking with these women and families can provide an amazing amount of hope, inspiration and understanding for mothers.
While a cesarean birth has many facets to its preparation and recovery, your labor and postpartum doula is knowledgable in supporting your experience. If you’re planning a cesarean and need additional support after speaking with your care team about what to expect, Maryland State Doulas is well versed and ready to be by your side for your birth.
The most important aspect of cesarean birth is that it is birth - having information and resources help to celebrate the amazing work you are doing to bring your baby into the world! This month, we celebrate our cesarean families for their journey and their beautiful birth experience.