Cesarean section (c-section) is major abdominal surgery used to delivery a baby. It’s not always traumatic but just because it is major surgery and often unplanned, birthing moms are usually unprepared for it in addition to giving birth. It can be quite shocking, and take you some time and support to integrate and recover. When I work with pregnant mom’s who are preparing for birthing I encourage them to go and see their local labor ward, etc and to think through how they want to handle it if a c-section becomes necessary. Most moms are very resistant to doing this because they are so frightened of c-section, but those who prepare handle it much better, and there is less of an aftermath.

Many moms feel overwhelmed during and/or after a c-section. It can result in feelings of loss and grief afterwards. Most moms have a birthing dream, which they have lost because they didn’t get to have the birth they most wanted. Feeling that your body has let you down, or that you couldn’t do it, can feel disempowering and reduce your confidence. Many moms also feel very grateful for c-section when they have had a long and difficult birth, or when it was medically indicated and saved their baby’s life. There are a whole range of responses, and of course mom’s can feel both grateful, and in grief, simultaneously.

Around 5-10% of the emergency c-sections carried out in hospitals are real emergencies, medically necessary, and save lives. The average c-section rate for the US in 2006 was 31.1%. This varies greatly between different hospitals and physicians, and can go higher than 50/60%. Hospitals don’t make their c-section rates public knowledge, so it is very difficult to make informed decisions about where to birth. You can always ask your physician about their personal c-section rate and shop around if you want to avoid a physician with a high c-section rate. Non-medically indicated c-sections make up the larger percentage of the overall number of c-sections carried out. Some of the reasons for this high rate are:

1. Obstetrical time management.
2. Liability issues for doctors.
3. Litigation pressures and fears for doctors.
4. There are a number of medically caused reasons why women end up with surgery when birthing – see “Failure To Progress & Why It Can Lead To a C-Section birth”.
5. Many doctors’ refuse to allow women to have a vaginal birth after a c-section (V.B.A.C.), which increases the c-section rates.
5. Hospital pressures and protocols.

The tools available to doctors in the medical birthing environment are drugs, electronic monitoring, and medical interventions. In a midwife attended birth you can expect to be supported to have your own timing and preferences.

Birthing women and babies in the U.S. are routinely attended by highly trained surgeons, which could explain why there is so much surgery at birth. Marsden Wagner, M.D., M.S., author of “Born In The USA: How A Broken Maternity System Must Be Fixed To Put Women and Children First”, when speaking at an obstetrical conference (he was once a pediatrician and an obstetrician himself) asked doctors in the audience to put their hand up if they had seen a natural birth – there were no hands. Is this not shocking information? I highly recommend Dr Wagner’s unique book, written as one who was once on the inside of our medical maternity system and is now an outspoken advocate for changing it and challenging obstetrical practices. The World Health Organization suggests that a 15% c-section rate is healthy, I personally think this is still way too high.

Here in the U.S. c-sections have reached shockingly high levels, and many medical interventions are carried out routinely in all U.S. hospitals during birthing. Jennifer Block in her book “Pushed: The Painful truth About Childbirth and Modern Maternity Care” interviewed a number of OB/GYN’s about this issue in her book and it is clear from their responses that c-sections are done for financial and liability reasons, and not because they are actually needed. E.g. if they think a baby is going to have shoulder dystocia during birth they will do a c-section rather than risk a malpractice suit from the parents. This is having a detrimental effect on mom’s, babies, and families and on our culture as a whole. C-section rates continue to rise, and other countries are unfortunately emulating the U.S.

Surgery and drugs at birth are NOT normal.

I would like to see a holistic model of birthing, one that includes the whole person – the psychological, emotional and spiritual as well as biological/physical – and the baby who is having her own experience. Babies are affected by drugs and interventions. Birth is a multifaceted experience for both mom and baby; it is also a sacred and transformational journey for them both. The medical environment is currently unable to hold a holistic perspective around birthing moms and babies. They have yet to begin to understand both the immediate and the long-term traumatic effects of so many extreme, routinely used interventions. I don’t know if they have even begun to consider these questions. Those of us working in the Prenatal and Perinatal Psychology & Health field are learning a lot about how these practices are affecting birthing mom’s, their baby’s, bonding/attachment, and family dynamics, and are supporting families back to health. Birth is a huge journey for all of us no matter how we come in, whether through c-section, or through the birth canal.

A Healthier Model for Birthing:
In the Netherlands midwives attend all births, and obstetricians are only called in for a real emergency, they have a c-section rate around 10%. This rate used to be even lower, around 5%, until women began to birth more in the hospitals and then it began to creep up. In hospital births in the Netherlands women are assisted by a midwife with no surgeon present. Drugs are not considered a normal part of birth in the Netherlands; they are not discussed or expected. The anesthesiologist only works office hours. If you are birthing in the hospital when the anesthesiologist is out there will be no drugs. The Netherlands is a great example of how we could be approaching birth, and I am using their c-section rate of 10% of births as a baseline rate for necessary and healthy use of surgery in birthing, even though I believe it can be lower. They show us that having highly trained surgeons attending births results in high surgery rates, and that the absence of surgeons at birth produces low intervention birthing with much less c-section.

Moms and baby’s needs should be at the center of birthing, most importantly a birthing mom’s innate knowing should be respected and her inner knowing, body sense, connection to her baby, and her confidence in herself should be supported and central at all times during birthing. Our aim must be to ensure that mom’s and baby’s have an empowering, ecstatic birthing experience and that they are in charge. Obstetricians and nurses often don’t know how to support a birthing mom’s innate knowing that she can do it, that she can trust her body, herself, and her baby. Birth in hospital is not seen as a natural and normal life experience, but as a disaster waiting to happen. Medical interventions often inhibit the extraordinarily deep letting go and opening up that is required to give birth naturally and safely, and all too frequently the medical interventions become the cause of the so called ‘failure to progress’.

Doulas & Midwives: Having Good Support for Labor and Birthing:

In a study on the effectiveness of doulas, a woman was put in the room with a birthing mom, and she simply sat there, inactive, the whole way through the birth. This reduced c-section rates by 25%, and other medical interventions significantly. Why? Because women need women to be present in the birthing room, the same woman throughout, even if they are not ‘doing’ anything, birthing is about ‘being’ and letting go into the ‘baby time’ zone.

I advise women who are having trouble free normal pregnancies to employ an experienced midwife and/or experienced doula to stay at home with them whilst they labor until they really need to go to the hospital. We have evolved into thinking that the moment we feel a contraction we must panic and get to the hospital immediately. Unless there is a problem, there is usually plenty of time! Birthing is not quick, especially for first timers. This early rush to the hospital is one of the largest contributors to c-section rates being so high, as the longer and earlier you are in the hospital, the more interventions you will receive, and the more likely you are to have a c- section. This is because interventions lead to more interventions lead to c-sections. If you are sure that the hospital is the right place for you to birth, you can take this supportive measure to reduce your chances of ending up with a c-section. In this way you can enjoy moving around, feeling safe and comfortable in your own home, eating and drinking as much as you like and having your privacy during labor. Your other children can participate if you wish; it is all much easier as the rules are yours. I want to emphasize though that you should not do this without the right professional support. Whilst these measures are for the prevention of c-section, you will enjoy the benefits of being relaxed and safe at home with familiar people around you, and this can only benefit your labor, and you baby.

A Holistic, Multi-Faceted View of Birthing:
We are holistic beings with multi-level needs, and many moms are unable to open their bodies to the arrival of their baby because they are not being treated as a whole person who can birth their babies themselves. Mom and baby are birthing together, it is a dance of two, and doctors have been unable to learn how to support this beautiful natural process, focusing instead on a fear-based model of controlling and intervening, and then speeding it up with drugs and pressure for their own convenience. We need to get back to supporting mom’s, and babies, in their innate ability to have a wonderful, empowering, ecstatic birth in an environment that centers itself primarily on those intentions.

Hospitals are for sick people, but birth is normal! It should not be happening in a hospital, nor attended by surgeons. I would like to see birthing centers popping up all over towns and cities, becoming a big part of people’s neighborhoods. They are a great alternative to hospitals, offering women who are not yet confident enough about birthing at home a great alternative to the medical birthing model.

© 2016 Karen Melton

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