Sunday, October 25, 2009

more on birth, because I know you love it

Oh, just when you thought the labor posts were over, I slam you with another. This time I'm solely focusing on Cesarean births. And, for your viewing pleasure, I first want to slam you with some statistics. Stay with me. It gets good.

US Cesarean Rates:

1970 - 5.5%

1975 - 10.4%

1980 - 16.5%

1985 - 22.7%

1990 - 22.7%

1994 - 21.2%

1995 - 20.8% ---> ACOG recommends VBAC for most women

1996 - 20.7% ---> New England Journal of Medicine says VBACs are dangerous

1997 - 20.8%

1998 - 21.2%

1999 - 22.0%

2000 - 22.9%

2001 - 24.4%

2002 - 26.1%

2003 - 27.6%

2004 - 29.1%

2005 - 30.2%

2006 - 31.1%

So if you walk into a hospital in the US, your chances of having a C-section are 1 in 3. Those aren't good odds. Not at all. Are the women of the 70s not the same women of 2009? Are the women of 2009 not the same women of 60 A.D.? The same uteruses that held babies and contracted in 800 B.C. are the same uteruses that we have today.

No, not the exact same. That would be gross. Ew.

I know. I sound a little bit crazy.

And while I do know that Cesarean births do save the lives of children and mothers (and thank goodness for that!), I do recognize that the United States has the 2nd highest infant mortality rate in the developed world. 70% of births in the world are led by midwives. In the US, it's more like 7%. We have learned to trust doctors with an iron fist and we've forgotten to think for ourselves. We are told things like, "You're too small to deliver your baby" or "Your baby isn't happy" or "Your baby is a 10-pounder, we have to get them out of there!"

And the percentages of C-sections in birth centers is about 4.5% - a huge difference from that of a hospital. So something is different there.

But sometimes your baby is breech. Sometimes your baby is transverse. Sometimes you're pregnant with multiples, and it's the safest way. Sometimes you just don't progress. Sometimes your baby becomes lodged. And when other tactics, such as getting in certain positions, moving, using birthing balls, and manually moving a baby don't work, a C-section is in order.

So you get dressed in your adorable little blue hat. They wheel you away and give you lots of anesthesia while your husband waits in the hallway for the go-ahead to come in. You're on your back, and you have a giant blue sheet draped in front of you. You feel pressure here and there, and your husband is telling you what's going on. Your newborn is pulled out of you, and they hold your babe above the curtain so you can get a look! They do major sucking because your baby didn't get a good massage from your vaginal wall on its way out, so there's extra fluid that must be removed. Your husband is peering over the curtain to get a better look, and you're stuck on your back. They finally bring you your baby burrito so you can give him a kiss and say hello. Then they stitch you back up and send you off to recovery from your major surgery.

And that's how it goes! Or, at least, that's how I've read and seen how it goes.

But have you ever heard of the Slow Cesarean? No? Neither had I, before I picked up this amazing book. It's another way of performing a C-section, and it pays close attention to details - and, guess what? It's slow.

-The drape that typically obscures a mom's view of her body is withdrawn as the baby emerges so she can see her baby being born

-At first, only the baby's head is removed from the uterus, allowing the baby to receive a few minutes of the benefit of a body massage as the uterus contracts

-Instead of quickly clamping and cutting the cord, the doctor leaves it intact and allows the baby to slowly acclimatize to the surroundings with support from the placenta's blood and oxygen

-As the baby seems to become more alert, the doctor hands the baby to the mom, who places her little newborn on her chest for skin-to-skin contact. This way bonding can begin. The baby awakens to the world hearing Mom's voice and smelling Mom's smell instead of being on a resuscitation table.

*Note: It's been proven that breast-feeding is easier to establish, and the baby is much more calm when a C-section is performed this way

There is another way! No one goes into pregnancy fantasizing a C-section as the end result. Well, scratch that. Some celebs (and average moms..) have been "picking" and "choosing" their baby's birthday by scheduling inductions for no reason other than it being a "good day" for them. I'm totally against this for a whole slew of reasons. Don't get me started. Or, please do, because this is my favorite topic.


The book also lists the World Health Organization Recommendations for the Best Birth. I find this to be very interesting, and I couldn't agree more:

-The well-being of the new mother must be ensured through free access of a chosen member of her family during birth and throughout the postnatal period. In addition, the health team must provide emotional support

- Women must participate in decisions about their birth experiences

- The healthy newborn must remain with the mother whenever possible***

- Immediate breast-feeding should be encouraged even before the mother leaves the delivery room. Unrestricted mother-infant contact after the delivery and unrestricted breast-feeding reduce breast-feeding failure

- There is no justification for a hospital to have a Cesarean section rate of higher than 10-15%. Vaginal deliveries after a Cesarean section should be encouraged

- Electronic fetal monitoring should not be routine

- There is no indication for shaving pubic hair before delivery

- There is no indication for routine enemas before delivery

- The dorsal lithotomy position during labor and delivery is not recommended. Women must decide which position to adopt for delivery

- Induction of labor should be reserved for specific medical indications

- The routine administration of analgesic or anesthetic drugs should be avoided

- Artificial early rupture of membranes, as a routine process, is not justifiable

- Enhanced social and psychological support from caregivers reduces negative outcomes. Leaving women unattended during labor should be abandoned

- Separating healthy mothers and babies routinely should be abandoned*****

- Repeating Cesarean section routinely after previous C-sections should be abandoned

- Restricted maternal position during labor and delivery should be abandoned. Upright versus recumbent position during first and second stage reduces negative outcomes

- Performing episiotomy routinely should be abandoned

- Inducing labor routinely at less than 42 weeks gestation should be abandoned

- Prescribing sedatives or tranquilizers routinely should be abandoned

I've bolded the statements that I feel strongly about. At the top of my list, probably, would be the idea that for a healthy mother and child, the baby should go straight to the mother's chest for skin-to-skin contact. Not weighed. Not measured. Not slapped with goop on the eyes to protect from from the Chlamydia and Gonorrhea that their mother doesn't have. On the mommy's chest for the best bonding moment of their lives.

The point is: there are lots of options out there, and your doctor probably won't tell you about them. Your doctor has a bunch of other patients, so you have to do your research to know what's best for your birth.

And, Note: I've never given birth, so I don't really know what I'm talking about! I'm just spreading the word of Ricki Lake, because I highly agree with her and think she's on to something...

Check out her book or buy it. I got ALL my information in this post from her book, Your Best Birth

Visit her website to learn more about how you can have your best birth!


  1. I'm so glad that research has evolved so quickly. During my mom's birthing years, because my sister was breech and they said a vaginal birth after a C-section was life threatening, I was a C-section baby too. She wishes all the research we have now had been out then, because she hated the C-section recovery. I can't imagine recovering from a SURGERY during the first 6 weeks of a child's life. Here we are, 20 years later, and we have come so far. It's a great thing. I think a lot of mother's view C-sections as less painful because the labor isn't as long, and don't think about the much longer recovery. Amen, all Mommies should do their research and only go for a C-section if absolutely necessary!

    That said, I also think our doctors need to be aware of NEEDING a C-section and not needing one. My poor sister NEEDED a C-section, because Riley basically got stuck. I don't remember all the details, but even though Riley was in the correct position, her head was turned at a strange angle that would not allow her to move through the canal easily. After lots of tearing and blood loss, Riley was finally born vaginally, but we thought for several minutes that we might lose Ash because she lost so much blood so quickly. I wish our doctor had paid more attention and realized that a C-section was necessary. I think a lot of times doctors see it more of a "luxury" rather than a necessity to Moms, and Moms that need one get overlooked while the ones that just want one get one for no reason.

    Whoa. Sorry so long. :)

  2. Wow. I know so little about deliveries. I *really* need to get that book! I do have a fear of being "too small" to deliver vaginally, or baby getting to be 10 pounds in the womb (which I highly doubt would happen in the first place, with docs monitoring the size of baby J. They'd induce me before baby J got that big, I'm positive!). I have *never* heard of a slow c-section. Can this be practiced at *any* hospital or just some?! Thanks, Shannon, you're really helping me to understand the extent of research I still have to do before baby J arrives! :)

  3. I have no idea, Brittney! I've NEVER heard of it either! Never ever! I don't really know that much since I've never given birth :) but I reeeally like researching it! My favorite topic ever!

    My biggest fear is that I won't dilate or that I won't progress.. or, like Riley, my baby will get stuck! Geez louise. Paigey, that sounds terrible!

    Hopefully, her next delivery (if she has one) goes a LOT more smoothly. That just sounds so scary!!!!! :(

  4. I'm definitely going to ask my doc or midwife about it, so I know beforehand. Hopefully it's a practice that ALL hospitals have to have the option of, they just don't let the mothers know, so it goes more quickly with the regular one. Lame.

  5. Yeah exactly.. that's one of the big points the book makes: that things ARE available, but you have to ask. and ask in advance so you know it's available.

    because, really, a C-section wouldn't be SO bad if you did a slow one and got to hold your baby and everything. there is hope! :)

  6. I've never heard of the slow C-section either! I'm with Brittney, I wonder if all hospitals do it? It sounds like something that doctors around here would send you to Vandy or something if you insisted on it. Then again, that might not be so bad. I'm not too pleased with BG doctors these days! Granted, they aren't OBGYNS, but still.

  7. Paigey, I *totally* agree.. I aint thrilled with BG doctors either. I've picked out a place to give birth, but I've not toured it or anything yet since obviously I'm not pregnant. but I highly lean away from hospitals and more towards hospital birthing centers.. things just go a lot more smoothly there :) statistically, anyway!

  8. I don't have any experience with BG docs, but I would *hope* they wouldn't just send you off to Vandy to have that if you just refused to have the "normal" one. That'd be crazy! I'll ask my doc/midwife soon...I have another appt on Thursday so I'll let you know what they say!

  9. Oh snap! Awesome!! You should also ask if he allows delivery in different positions other than just laying on your back.

    Onto a totally irrelevant topic, I saw labor gowns today that looked SOOOO you. They had brown birds with orange limbs of branches. like, silhouettes of birds. totally Brittney Jones. I'll see if I can find it. I totally want to buy one for the hospital!

  10. YAY!!! I love this topic because I feel the same way...When I was preggo with maddox i had to have a Csection due to placent previa, and well when I got preggo 7mths later with Jakk I wanted to weigh my options but everyone around me kept saying juat do a csection its "safer"! Well I had a csection and in normal situations its NOT safer! Well the Dr. and I decided that since my uterus was still healing it would be safer to do a RCS this time which was a good thing because my uterus almost ruptured! Well anyway after having 2CS I am STILL going for a VBAC next time! A vaginal birth is the best option along with going into labor on your own! A baby should pick their own birthday, and even though I had 2CS I labored on my own both times! I need to get this book Shannon! It sounds great and is definitely what i need when preparing for my several years!

  11. I think you'd really love The Business of Being Born. Its a documentary. I haven't seen it, myself, but I've heard great reviews about it from a lot of women. Many of them said they'd prefer to birth naturally at home after watching it.

    I also read a birth story from a midwife's perspective about this woman that NO ONE thought could birth vaginally. Her pelvis was so small, but she did all the labor positions and although it did take a while for her to push her baby out she did it. I'm a member of a natural birth community and so many women have given examples of when a doctor would prefer not to let her deliver vaginally but she was able to (not to mention scary stuff like Pit to Distress - where a high amount of pitocin is given to the mother so that her infant goes into distress and they can c-section her instead of waiting for the baby to be born)

  12. I've alllllways wanted to see that documentary!!! Plus, doesn't it show Ricki giving birth at home? I've seen her interviewed on different shows about how hard her at-home birth was, but of course she LOVED it! :]

  13. My sister just had a baby, and she was in the women and children's center---it was really, really nice. Much nicer than just a regular hospital. Vaginal births are done right there in the room. My sister ended up having a C-section though, because her blood pressure was so high that it was threatening her life (could have had seizures and stuff). Now she just had a regular C-section, but her recovery time was crazy-fast. I mean, she was a little out of it for a week or so---because of the blood pressure meds though. She said she recommended the C-section, because it was just really easy for her. And she said it didn't hurt--even the recovery.

    However, after reading all this stuff--I'm loving your slow C-section thing. Obviously I'm not even MARRIED yet, yet alone anywhere near being pregnant, but the thought of giving birth just kind of overwhelms me. But I'm loving this slow C-section. It sounds great. =) Loving your research!

  14. Shannon I must say you have completly changed my outlook! Even though I am nowere near being ready for a baby, my GYN told me that I was to small to give birth naturally and that I would most likely have to have a C-section. After reading your blogs you have convinced me that I don't need to settle for what he says. When I go become pregnant I want to look for a midwife (as long as they aren't too expensive, but I will look more into that when I need to). Although I am scared of the pain that comes with birth, I think I would be happier with myself after if I tried naturally. Keep posting these blogs with info! I love them!


  15. aww, YAY, Rebecca!! :D I'm 99% sure that midwives are covered by insurance just like doctors. My book (and others) say that midwives are actually MORE educated on *vaginal* births than doctors - because doctors are prepared for the worst (emergency C-sections, serious problems, bleeding out..) all the bad stuff... but as long as you're healthy, and your baby is healthy, and you're having a vaginal delviery, the midwife knows more about that! It's very interesting info :) Thanks for commenting!

  16. i LOVE that you are obsessed with birth! :)

  17. I would go with a doula! I would have not made it through natural childbirth with out mine!!! There is something about going through labor and not being able to focus and remember in the moment all that you have read :). She was also a strong Christian so that was comforting, a real Blessing! Also The Thinking Woman's Guide to a Better Birth and The Birth Book by Dr. Sears are really good reads