Birth By Surgery: Can the C-Section Be "Natural"?

Many of you read and supported me in my “Medicalization of my Natural Birth“. Thanks, yo.

I never had to face a Caesarean section. Not with these birthin’ hips. I know, and am even related to, women who have. It’s a tough recovery for many, both physically and emotionally.

Now there’s a movement to make the C-section more “natural”. Vaginal birthing has had a natural movement over the last 20 years, and one doctor wants the C-section to have the same.

British professor Nicholas M. Fisk wants to encourage the same bonding that is present in many natural vaginal births in his C-section patients. He thinks C-sections should be more “woman-centered.”

But with 1/3 of all American labors ending in surgery (in the UK the C-section rate is 24 percent), is this something we should encourage? Do we really want him to soothe us into the decision of a C-section?! “There, there. At least it’ll be natural.”

What’s next…is he going to “naturalize” the vasectomy?!

Here’s what happens in this OB’s “natural” C-section.

  • Just as in a sterile C-section, the curtain goes up so the parents don’t see the incision and so the environment is clean.
  • OB slows “delivering” the baby so mama’s contractions can clear baby’s lungs, “just as happens at a vaginal delivery”.
  • The baby’s shoulders are delivered, and then the proud parents are allowed to watch the rest of the delivery.
  • Baby is placed on mamas chest for bonding.

Don’t get me wrong; I know that some C-sections are honestly medically necessary. But I also know women who have been bullied into it. They feel like if the doctor says it’s so, it must be.

But there are WAY too many C-sections up in here. 2007 marked the 11th straight year for an increase in the procedure. And this rate has climbed 50 percent in the last decade. The number of vaginal births after C-section (VBAC) are on the decline, further increasing the C-section rate. The World Health Organization wants a C-section rate of no higher than 15 percent anywhere in the world. Considering that half of all C-sections are elective, I’d say we could trim down a bit!

I get that medical professionals are scared. We’re in an era of litigation. But please, can more doctors stand up and say bravely,

I’m ready to stop practicing defensive medicine. I’m ready to let women experience natural labor without interventions unless absolutely necessary.

I know this is a tricky topic. Women are all across the spectrum of guilt and satisfaction and delight with their birth experiences overall, especially when they give birth by surgery.

If this “natural” C-section is going to empower women and families for whom the surgery is actually necessary, that is fantastic. I’m all for bonding from the first and making each birth experience the best it can be.

But if this is a ploy by the medical community to dress up a wolf in tie-dye and Kumbaya songs, no thanks. If we want to make the C-section more like a vaginal delivery, might we move toward the actual natural birth for the many strong mamas out there?

Image: Focus by Kelly Sue on Flickr under a CC License.

Comments

  1. Beautifull story. I suggest also this blog
    http://healthmedicine-today.blogspot.com/

  2. OB’s should ONLY be assisting at high risk pregnancies and situations that must end in c/s in order to save lives. Then they would have the time to really spend with their patients, address concerns, and take their time with “natural-ish cesareans” Reducing the overall number of women in the hospital giving birth (by having a system that supports low risk, healthy moms birthing their babies at home with trained professionals like CPM’s and CNM’s) would allow moms who birthed through surgery to stay in the hospital longer and receive the one-on-one medical care that they so very much deserve. 3 days is not long enough to recover from a cesarean, learn breastfeeding, adjust to being a mom, catch up on some sleep etc… when you have perfectly healthy moms who may need to labor for 2 days, competing for bed space, nursing and hospital resources, right along with the moms who have had surgery, someone is NOT getting the care and support that they really need.

  3. Interesting.

    I think your concern is completely appropriate because I don’t think it will help a woman who is choosing an elective c-section (though she certainly has that right) to feel even better about it because there is an emphasis on how mother-friendly aspect of the procedure.

    On the other hand, women need to start demanding more respect regardless of the procedure. The way we are allowing our bodies to be treated is atrocious and I think many, many doctors could stand to use compassion and respect when doing a procedure like a C-section. I think most of the behavior is horrible, but I don’t blame the doctors. It is the responsibility of the women to demand the best for ourselves and our babies and the responsibility is for us to find consensus among ourselves, not pass it off to the medical community. I don’t much care what kind of birth you choose to have, but own it and know you deserve respectful care.

  4. You know, I had three c-sections, all medically necessary for several reasons. I did have guilt after the first one, but have gotten over it. Once I realized there was really no choice and I got a healthy baby because of it, I let it go. I have to say that I felt that all three of mine were as ‘natural’ as possible. None of my babies were separated from me, I got to hold them throughout the time I was being put back together, with my last one when I couldn’t hold him my husband never stayed with him constantly and held him the entire time. He even took his shirt off and took off the blankets from the baby and held him to his skin until I could put him to breast.

    I think the problem is four fold. We have insurance companies determining how long a mother can stay in the hospital, doctors afraid of litigation if the smallest thing goes awry, parents who are only too eager to sue the doctors, and hospitals who don’t give enough education to mothers considering c-section or educating those mothers who do have c-sections on how to recover from them. In all, we have a complete society who refuses to take accountability for anything and who wants to blame and get paid for everything in the form of litigation. So, your not just talking about a change in how doctors view birth, but the entire society which is much harder to change. I know of a lot of women who beg for a c-section *as a first time birth* with no medically necessary reasons, they just don’t want to go through the pain of labor. How disturbing is that!?

    I must politely disagree with the previous commenter on 3 days not being long enought to recover well enough to go home after a c-section. I begged to go home after one night in the hospital with my 2nd and 3rd c-sections because I knew I would get better rest at home than in the hospital. Once you know how to recover from a c-section it is not that hard. I wanted my baby out of the hospital environment so we could bond and breast feed in peace. This is where the education of recovery would help immensely.

  5. I have to agree with Kitty. I had a medically necessary with my son. I also had a wonderful experience. I nursed my baby right away, he roomed in with me and was never out of our sight.

    I was ready to go home within 24 hours. The first 24 hours were the toughest, but after that I was fine. Even though I had help at home, I was up and around and did everything for myself.

    In fact, I did a car trip with my baby when he was only 7 days old. We did great and while I do not condone elective c-sections for scheduling or non-medical reasons, I also think they can be a beautiful and wonderful experience for the family.

    It was for us. =)

  6. I think women deserve and should demand the best care regardless of the type of delivery. I don’t think encouraging bonding during a c-section is the issue, or would necessarily drive increases in this area.

    Rather, we need to examine the ‘picture’ much earlier on to investigate what societal factors/medical practices are herding women in this direction – outside of medical necessity – and try to alter the course before she arrives at that destination.

    If she is already at the point of delivering via c-section, then I feel that anything that improves the experience for her and her child would obviously be beneficial for them both and should be promoted.

  7. I absolutely hear your concern regarding the possiblity of Cesarean Birth being “naturalized” without addressing the root issues around modern maternity care and our high Cesarean rates.

    However, I applaud and celebrate this new approach to Cesarean Birth. As a Birthing From Within mentor I strive to support parents in birthing in awareness whether they are at home or in the OR.

    We recently began mentoring a “Birth by Cesarean” prenatal class for clients needing to have a planned cesarean for medical reasons. It has been remarkable witnessing the commitment of these families to be fully present and connected to their birth experience.

    In preparation for the workshop we did a series of qualitative interviews with over 20 past clients who had birthed by Cesarean. They offered up courageous, insightful perspectives on their experiences and I am hopeful that this new approach to Cesarean Birth spreads beyond a few radical OBs to be an option for more families.

  8. While there is no question that there are times that c-sections are necessary, the problem is that more and more that is not the reason they are done. I too think that the time and energy would be better spent educating woman on the benefits of natural, vaginal birth and the true risks of elective c-section rather than re-branding c-sections as “natural”. Obviously for woman who have no choice the procedure should be made as positive as possible, but unfortunately as it moves to become the “norm” in many ways to schedule an elective c-section for reasons that have nothing to do with the health of baby or mother, I think I tend to see this as a wolf in sheeps clothing too…

  9. I have pointed out before (in my “Medicalization” blog mentioned in the first line of this) that no matter how strong or natural-birth educated you are, sometimes you just feel pressured to go along with it. Any intervention. They’re the “professionals”, so they know better. One bloggy friend was actually told she’d tear from top to bottom if she gave birth vaginally. After 2 C-sections, she did a home VBAC. You can read about how wonderfully it changed her family here:
    http://millermemoir.blogspot.com/2009/04/guest-blogger-my-husband-on-birth.html

    For example, I was blogging away on natural birth and natural induction methods, but my medical midwife was pushing me to induce by 41.5 weeks, even though by all their interventions and tests, he was measuring “small” and my placenta was certainly fine to wait. Luckily, my son is as stubborn as I am and we went into labor the morning I was set to be induced. Even then they tried to intervene, though I was at Transition when I arrived!

    If this could happen to me, who has had 5.5 and 2.5 labors, respectively, I fear all the interventions that push women eventually down the road to a C-section.

    My oldest sister had an emergency C-section with her older son. He was literally stuck in the birth canal, approaching for too long. (And now she works with a special needs girl who had the same thing, only they waited and gave birth vaginally, so my sister is thankful she made that choice.) But my sister was then slightly “pushed” to have a second C-section. And though her second was also large–but not quite as big–I wonder if this strong, marathon-running woman could have had a VBAC. If anyone could, it was her.

    While the “natural” C-section is a blessing for those who need it, I don’t want women to choose it over the blessing that is a natural vaginal birth.

  10. My grandmother was told in 1950 when her first child was breech that “we *MODERN* obstetricians have no trouble delivering a breech baby vaginally.” And he did it just fine.

    My mom was advised in 1977 by her obstetrician to have a c-section when her first child was breech, but was willing to attempt a vaginal delivery when my mom said that’s what she wanted. And it was just fine.

    In 2002, when my first baby was still breech at 34 weeks, my obstetrician flat-out refused to attempt a vaginal delivery as did every single other doctor at the military base where we lived (I was required to deliver at the base hospital or else pay for the entire cost out-of-pocket, which we could not afford). Fortunately, my baby did turn but had she not, I would’ve been stuck getting a c-section.

    Why is it that the 1950′s era doctors could do vaginal breech deliveries but not the 21st century ones? Aren’t we supposed to be making progress?

  11. On that note, Crimson Wife, I was a home birth myself in 1978. In the Chicago blizzard of ’78, though my memory fails me of that. ;) My mom was having her first home birth (me) and labored for 28 hours, taking walks through the high snowdrifts with my dad. Then the midwife arrived, though not the home birth doctor. I wasn’t breech, but my left hand was “stuck” up by my shoulder. My mom gave birth to me fine with the help of this midwife, and though they were worried about how easily I could use the blueish-purple appendage, I’m a lefty.
    Doctors are scared today. I do blame it on this litigious society. They’re too scared to let women labor and deliver, because in the rare case that something bad should happen, that’s they’re butt on the line. I understand that.
    Honestly, I think it takes women and families being educated and empowered. I think it takes midwives and doctors who trust in their patients’ abilities. I think it takes these medical care professionals walking through the birth plan and discussing how/when medical interventions might truly be “necessary” and not only for expediency. I think the whole birth process is owed a lot more trust than it currently it given.

    A correction: In my earlier comment, I wrote 5.5 and 2.5 but didn’t say that those were how many *hours* I labored before my two boys were born. Clearly, a woman who can give a quick, natural birth for her first has a good chance of doing it again without the interventions they tried to give me!

  12. Michelle Q says:

    Just something to consider when discussing Dr’s who “push” for a repeat c rather than VBAC – more and more Docs in our litigious society are having their hand’s forced by insurance companies who either will not insure or who charge dramatically higher rates for malpractice if they choose to offer VBAC. Which, in and of itself may not seem that significant (pay or find another insurer), BUT in an era where many areas of the country are facing dire shortages in the OB fields . . . well, the situation just isn’t always so easily black and white.

    Personally, I had 2 very medically necessary c’s. I’m very happy with the experiences I had, the guidance of my Dr, and the end result (2 beautiful children who have their mother here with them today). Frankly, I get a bit amused by the feigned pity and thinly veiled judgements I often encounter about it. I feel no need to defend my choices at all.

    It’s not right for every situation, by any means. Nor, however, is it an evil that need be eradicated.

  13. My first c-section was medically necessary. My son was transverse and my water had broken 7 weeks earlier. It’s a miracle we both survived.

    I have complete peace about that surgery.

    My second. Woah mama. I went into the hosptial at 36.4 weeks having some mild, but consistant contractions. We live 3 hours from the nearest relative, so we called them to give them a heads up, but assumed we would just be sent home.

    Nope. They checked me and I was 3 cm dialated. At this point, although no one made any mention of fetal distress, they began treating me as an emergency and told me they would be delivering my baby within 30 minutes. My husband and 3 year old son had to wait outside, and I went into the OR alone. I had never met the doctor who delivered my baby and no one could give me an explanation as to why everything was such an emergency. I was so overwhelmed by the urgency that I didn’t fight for myself or my baby.

    I was told after the surgery that I was not in true labor. To this day, I have no idea why they forced the c-section. This was less than a year ago so I haven’t been back for my yearly exam. I’m planning on requesting my medical records to try to figure out what happened. Honestly, the subject has been too raw for me to examine until now.

    My baby was taken away after being shown to me for a few minutes.

    I’m all for making the c-section experience better, but I think we should really try to figure out how to reduce situations such as mine.

  14. “But if this is a ploy by the medical community to dress up a wolf in tie-dye and Kumbaya songs, no thanks.”

    I used your quote (with credit) in my presentation at this past weekend’s ICAN conference. It elicited a vey “knowing” laugh and was a terrific shorthand way of pointing out that women who accept Platt & Fisk’s extortion to schedule their “respectful cesareans” aren’t getting any respect at all!

  15. Thanks, Joni! ;)

  16. I am so thankful to live in a time where elective c-sections are an option (and bottle feeding over breast-feeding, and any other non-traditional method of childbirth/childrearing).

    A baby is a blessing NO MATTER how he/she is brought into the world!

    Its time to get over the “Im better than you because I used my vagina to give birth” or “c-sections are ok, but only under these medical complications that I have decided on” stigmas!

    Thats my little rant :) I am excited for my elective scheduled c-section knowing that it will be done in calm, stress-free environment and in about an hour or less.

  17. Come on!!!! Do you really think that Fisk is motivated by his wanting to “soothe us into the decision of a C-section”? Most of our doctors who don’t give a flip about the “positiveness” of our birth experiences might wish to so “soothe” the wool over our eyes, but would they go to Fisk’s actual steps of making the cesarean a nicer experience for us? Doubt it.

    I am currently pregnant with a complete and central placenta previa and I *have* to plan a ‘C’ for my delivery. Words can’t express how badly I am upset by this, especially having already had a quite negative ‘C’ experience. When I read about Dr. Fisk, I was really Happy that someone out there is indeed giving a **** about those of us who value natural birth but are not able to have one! I am appalled that I have found someone KNOCKING him for it!!!

    Even though Dr. Fisk won’t be able to help me directly, I intend to carry printed articles about his theories to my doctors to use as ammo/backup in begging for just a little kinder consideration than c-section patients are typically given around here. Thank goodness someone out there cares.

  18. As someone that will probably be having a 5th. c-section at some point, yet is all for natural birthing, I can say that the encouragement of having a more natural birth is being pushed by c-section women, not the doctors.

    Many of us recognize that things did not go as baby/mother friendly as they could have during birth and are asking our doctors to do things differently.

    Doctors could easily say “no” and refuse to do things in a more natural way. Sticking to standard procedures is easier than accomadating a women asking to do things differently. Thankfully, though, they are starting to listen to us and are realizing that even though the birth is not “natural”, there are things that can be done to make the birth better for Baby and Mother.

  19. Lucida Albers says:

    Almost 22 years later I still remember my 2 c-sections and I thank god every day that I had them, it saved my babies lives.

    When I gave brith to my son vaginally in 1986 the doctor advised me if I had another baby I would have to have it by c-section because I am so tiny inside. During my pregnancy as my son grow inside me I had very little room, I was throwing up 4-5 times a day and had to be very careful about not wasting room on empty calories. My son weighed five pounds and got stuck in the birth cannal, if he had been ounce more the only way to get him out would have been to break his ribs, as it was they had to cut an episotomy in both directions and were near breaking my pelvis in order to free him (it took 2 months to be able to stand and resume my life after his brith). He spewed so much mercounium during that time me and my husband thought he had green skin when he was born coated in it. Thank god he was okay. I never felt the urge to push, my uterus had already ruturpted by then. Three years later I was preagant with my daughter. I walked into the doctor office saying I wanted a c-section because I am very tiny inside. He took one look and told me it couldn’t be true. So I went into labor this time I was ready, screamed for drugs and threatned to hurt the doctor if he wouldn’t give them to me. I felt as my uterus rip open again and I knew that my eight pound little girl could not be born naturally. I watched her heart rate tanking on the moniter. My husband was outside with the doctor very upset. To make a long story short my daughter was born by c-section and I had lots of stiches, when she came out there was a loud popping sound, like a cork from a bottle. The problem with my daughters bith was that the insurance company didn’t want to pay for a c-section. 21 years ago we had manage care, I had just given brith and my doctor left me on the table to go and call my insurace to get permission for the procedure.

Trackbacks

  1. [...] Which women were “low-risk”? Those who had no known complications, such as a baby in breech or one with a congenital abnormality, or a previous Caesarean section. (Though a dear bloggy friend had her best birth ever when she had a home VBAC.) So…wouldn’t “low-risk” include most women? Even though we’re trying our damnedest as a culture to up the C-section rate? [...]

  2. [...] C-section is now the most common procedure performed in the United States. A third of American children are [...]

  3. [...] Washington state has a new cost-cutting program that may also dramatically lower the rate of C-sections. [...]

  4. [...] medical interventions are sometimes needed. Pitocin, fetal heart monitoring, C-sections: these have helped in some [...]

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