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In short, cesareans are a common happening. Whether they are necessary or not can make little difference if it wasn't exactly what you had in mind for your birth. Giving birth this way can be a lot to deal with - physically, emotionally and spiritually. I do not have personal experience with cesarean, but I have had many friends, family members and some clients come to me in need if a listening ear after an unwanted cesarean.

At first it was my goal to provide information about coping with an unwanted cesarean in sharing the stories of these beautiful women. They have each coped and healed in their own ways and in their own time. They were both amazing and brave throughout their experiences, and after talking with them I've decided to just share their stories and their advice. I feel so blessed when other mothers open up to me and share their journeys. I am thankful for and have been touched by both of these stories.

Natalie shared with me the birth of her beautiful little Danica, born May 16, 2012. "My husband and I had been trying for over 3 years to become pregnant." Natalie had an ultrasound at 19 weeks and found that her baby was breech, unconcerned at this point, knowing that baby had plenty of time to turn. The weeks passed along and at 29 weeks she found that her little one was still ready to be born feet first. Natalie's obstetricians were not trained to vaginally deliver a breech baby. "After this appointment I was so scared, my worst fear was having to be stuck with a c-section. I was not a fan. I was reassured that baby had plenty of time to turn, even on the day of delivery. I hung on to that little bit of
hope."

"I was uninformed about preterm labor until 3:00 am on May 16th, 2012 when my water broke at 35 weeks. I called my parents and father-in-law, quickly packed a bag and off to the hospital we went. Luckily, registration didn’t take as
long since I was there only a week prior. I was then taken by wheel chair to the OB floor where they checked to make sure that my water had really broken. After that I was put in a labor and delivery room and where I received an IV. I informed them that baby was breech. You could clearly see her head under my right breast, very high!"

Natalie had an ultrasound to confim that baby was still breech. Upon finding that she was, she was informed that all five of her doctors were off call and that a doctor she had never met before would be performing her cesarean. "There was no option for me to say 'I want a natural childbirth', ever."

Natalie's experience was a little less than ideal for most people, from having the anesthesiologist try a total of nine times for a spinal to uncontrollable shaking. Through all of this she says that she truly felt that she was in great hands. "We all talked, laughed and cried, as my daughter, Danica Lynn Martin was born into the world at 7:00 am, May 16, 2012 weighing 6lbs, 4oz and 18inches long. She was beautiful, breath taking, and I couldn’t wait for them to reach her into my arms so I could kiss those cheeks!"

Danica spent the next 7 days in NICU. "The first two days were spent with oxygen, slowly weaning her hour by hour. The third day was spent on room oxygen, still hooked up to IV. That was my happy day, I was able to breastfeed her for the first time! She was a natural. The fifth day I was given the hope of us getting to take her home, only to be let down when we found out she was jaundice and had to stay. I was able to stay 3 days in the hopsital while she was in NICU. The fourth day they allowed my husband and I to stay in a room in NICU, since I was exclusevily breastfeeding. The last few days I spent at my father-in-law's house close by, since I was unable to breastfeed due to he being under lamps for jaundice. It was the hardest thing I ever had to experience in my life, leaving behind my newborn baby at the hospital. It was a nightmare, yet, looking back I'm grateful for being able to go to a place where I was able to actually take a shower, snack, and let my body have some much needed rest. She was a week old when we brought her home. Finally! We thought the day would never come."

Natalie is still thankful for a perfect pregnancy. She loved and trusted her doctors throughout the entire experience. While pushing herself with little rest after Danica's arrival, Natalie was determined to successfully  breastfeed her little girl. During her recovery, the traveling back and forth took a toll on her body. The positives helped make Natalie's experience more
so. "My daughter was worth it. I felt after each breastfeeding session that I had helped her, in some way. The bond we
shared during those moments were the most heartwarming to me. That's why I pushed myself, the traveling back and
forth. I knew her being skin to skin to me let her know I was still there, to protect her and help her get better to come home, where she belonged! My scar reminds me of all those precious moments of her being in my belly."

Natalie also has some thoughtful input and practical advice for other moms facing cesarean, "Try not to compare your pregnancy to someone else's. I listened to cesarean horror stories, causing me to fear the worst with my cesarean. My experience ended up being better than I could have ever imagined, despite her deciding to come early and having a NICU stay because of it. I'd also recommend plenty of rest, don't be afraid to tell family hours they can or cannot visit, you'll need it! My last bit of advice would be to wear the support binder and get up a move around. I pushed a wheelchair to the NICU from my room. If I felt tired, I'd use the wheelchair, otherwise I'd push it the trip and back. I feel it helped me from being too sore!"




Shantana's story is that of another breech baby. She also experienced high blood pressure, proteinuria and severe dehydration. "Our precious Gracie was born July 21st 2012 at 6:16 pm via cesarean weighing in at 8lbs 7oz and 20 ¾ inches long. Looking back upon the entire experience I am thankful to God, for I know that He was with us and that He helped us through it all. My c-section was not the experience I had hoped for when I made a birth plan for my little Gracie."

During a hospitalization at 37 weeks, Shantana went into a relatively quick labor. With a steadily high blood pressure, things went quickly for her once she was dilated 5 cm. "Within 15 minutes I was prepped and ready to go back for
surgery. Ryan (my husband) was given scrubs and enough time to make the needed phone calls to our families. I was thankful that my mom was already there. I was so scared. I can honestly say that life felt like it was going by in slow motion. I could feel my heart beating in my chest. I wanted to cry. I wanted to wait. But, mostly I wanted my baby to be safe. I was wheeled back to the delivery room and given a spinal. Ryan was told to wait outside until they had me prepped.They would come get him. However, because of my swelling the anesthesiologist was unable. After several failed attempts I was put under general anesthesia and Ryan was sent to the waiting room. I remember tears running down
my face, feeling lost without Ryan, praying inside my head and the doctor saying, “We’re ready on this end.”

The next thing I remember was waking up in tremendous pain. I literally thought I was dying. I could feel my wound and I didn't know anything about my baby. I remember crying and asking my mom if Gracie was okay." It would be three hours before Shantana would hold her baby girl for the first time. "I had plans for kangaroo care, I wanted to be the first to hold her, to feel her, to see her beautiful face but it had been three hours and it seemed I was the last.  No matter the pain I was in, the sheer excitement and pure joy I felt when I held her in my arms is a feeling unlike any other. In that instant, I realized I was indeed the first to hold her-in my belly, the first to feel her move, and although I didn’t see her face, the first to know her."
"Complications arose shortly after and my Gracie was put in NICU. The doctor explained that because she was born early and because of my blood pressure problems, she wasn’t able to regulate her own blood sugar and it kept dropping
below 30. She spent three days hooked up to every IV in the place it seemed. I had lost a lot of blood during the surgery so I was allowed to stay in the hospital. This was great because I was afraid I would have to go home without my
baby, and that terrified me. I was able to breastfeed her on the second day (although I tried to pump the first day to help my milk come in), within three feedings Gracie’s sugar began to regulate itself and slowly she was weaned from all IVs. Although I was exhausted and sore I wheeled myself down to the NICU every three hours to feed her. That was all I could do for her, but it ended up being the best thing anyone could have done. 

After, what seemed like forever, we finally made it home. Mommy, Daddy and our miracle, Ms. Lyndon Grace. I am blessed to have all that I do and although I would have liked for things to have gone much differently, I am glad in the end that Gracie is here, happy, healthy and above all - loved."



As a doula, I live for normal birth. I breath it. It's beautiful. I can't get enough. I often think of cesarean in a negative way, as so many are unecessary. In all honesty, three years and I'm still learning about it. I don't know all that I probably should about cesarean, but I'm getting there. It does my soul good to hear these stories, to see the beauty in these births and the love that these mamas feel for their children.

To my cesarean mamas - Take time to grieve for the birth you had pictured all along. It is entirely possible to be sad about your experience, and SO happy and thankful at the same time for your precious new baby. It's okay to grieve. You'll need time to heal physically and give yourself rest, all while caring for your newborn. So, ASK FOR HELP! Friends, family - anyone - most loved ones will be more than willing to help with cooking, cleaning and older children while you spend time caring for your little one and for yourself. Talk about what you've been through. Write it down. Tell a friend. Tell someone who's been there and heal together. Find a local I-CAN chapter. Let it all out! It's okay to feel what you're feeling and it's okay for others to know. Share here! Your story is beautiful and it deserves to be told.  















 
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The World Health Organization recommends that the cesarean rate for developed countries should be somewhere between 10-15%. Studies show that the best outcomes for mamas and babies occur with cesarean rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006). The average cesarean rate in the US is around 32.8% - much higher than the WHO recommendation. The average cesarean rate in Kentucky is actually a bit higher than the national average at 35.4%. The hospital with the highest cesarean rate in KY is Paul B Hall Regional Medical Center, with a rate of a whopping 71%.

Why are cesarean rates in our country so high? More importantly, why are cesarean rates in our state even higher than our high national average? A few reasons come to mind:

- Lack of evidence-based care
- Lack of support for the laboring mother
- High instance of unnecessary labor intervention
- Small amount of care providers who offer VBAC
- Lack of awareness of the harm that can sometimes come from cesarean
- Obstetricians are paid the same amount whether you deliver vaginally or by cesarean. Sadly, a planned cesarean is a great way for doctors to work births around their own schedule.

So, is it even possible to meet that WHO recommendation of 10-15%? It is.. and there is actually a place in our country whose cesarean rate is well below the national average, as well as the WHO recommendation. The Farm Midwifery Center in Summertown, TN has maintained an average cesarean rate of 1.7% from 1970-2010. Of 2,844 pregnancies, only 50 ended in cesarean. This really gives us an idea of just how many cesareans performed in the US are actually necessary, doesn't it? It certainly shows what is possible when evidence-based care and education are provided to mamas who absolutely deserve it! Why shouldn't every mama receive this kind of care?

Before delving into how to avoid an unecessary cesarean, I first want to talk about the risks that come with having a cesarean (whether necessary or not). Most importantly, the maternal mortalitly and morbidity rates are much higher with cesarean than with vaginal birth. Many women who have a cesarean section also sometimes have negative feelings about their birth that last well into the postpartum period. There's the possibility of a reactions to one of many medications that are associated with cesarean (anesthesia, pain medication etc.). With a cesarean, the average hospital stay is 3-5 days - with a vaginal birth it is only 24 hours. Along with the extended hospital stay comes an extended recovery time that can have a negative effect on bonding with baby and breastfeeding. Cesarean surgery itself can cause a delay in the milk ejection reflex, and mamas who deliver babies via cesarean often experience a delay in their mature milk coming in. 1 in 14 mamas report incisional pain six months or more after surgery (Declerq ER , Sakala C, Corry MP. Listening to Mothers: Report of the First National U.S .Survey of Women’s Childbearing Experiences. New York: Maternity Center Association, Oct 2002). There is a risk of scar tissue that can lead to complications in future pregnancies including placenta previa, placenta accreta and placental abruption. Infection can occur at the incision site, in the uterus and in other pelvic organs. There is a chance of injury during the surgery to other organs that are close to the uterus. There is more blood loss in a cesarean than in a vaginal delivery, 1 in 6 women require a blood transfustion (Shearer El. Cesarean section: medical benefits and costs. Soc Sci Med 1993;37(10): 1223-31). Along with all of these things comes the risk of additional surgeries - hysterectomy, organ repair, future cesarean.

The previous mentioned risks are those for mama, there are also risks for baby involved with cesarean delivery. Babies who are born via cesarean are more likely to have lower APGAR scores, reasoning behind this can come from a number of problems with cesarean - the anethesia and the lack of natural stimulation for baby provided by a vaginal birth to name a few. If your due date was not estimated correctly, a baby born by planned cesarean can be born prematurely. Babies born by cesarean are much more likely to have breathing problems and are more likely to need assistance breathing shortly after birth than babies born vaginally. Rarely, there is a risk of injury to the baby during a cesarean. On average 1-2 babies in 100 are cut during the surgery (Van Ham MA, van Dongen PW, Mulder J. Maternal consequences of cesarean section. A retrospective study of intraoperative and postoperative maternal complications of cesarean during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997; 74 (1): 1-6).

Avoiding an unecessary cesarean, and the risks that come with it, can be done in a number of ways:

- First and foremost, if you aren't in an emergency situation, question your care provider. Why is this being recommended? What are my other choices? What are the risks and benfits of having the surgery? Of not having the surgery?
- Plan a birth that is low intervention and find a care provider who is supportive of natural childbirth and supportive of your decisions. Each intervention in birth (induction, epidural, continous monitoring) greatly increases your chances of cesarean. These things can also sometimes be necessary - but when they aren't you have to ask yourself, is it worth the risk?
- When you find a care provider, be sure to ask their cesarean rate. It may be higher than even the national average and that's never a good sign.
- Educate yourself by taking good (out of hospital) childbirth classes, reading books recommended by your CBE or doula and by asking lots of questions of your care provider and support team.
- Discuss with your care provider spending early labor at home. A common reason for cesarean failure to progress. Usually, when given enough time, mama will progress just fine on her own.
- Avoid continuous monitoring.
- Avoid getting an epidural, especially early in labor.
- Avoid induction, unless medically necessary.
- Hire an experienced, professional doula. A doula will be able to help keep you comfortable without the use of modern medications and will also be able to help you find positions that are conducive to the natural progression of labor. If something does come up during your labor, your doula will be there to answer any questions you have and provide you with accurate information to help you make the best decision for both you and your baby.
- If you've had a previous cesarean, find a doctor who is supportive of VBAC and discuss your options. "Once a cesarean, always a cesarean" usually isn't the case.

While cesareans are scary and come with plenty of potential side effects, they are sometimes necessary can be life saving. Some cases in which a cesarean may be necessary are placenta previa, placental abruption, placenta accreta, uterine rupture, cord prolapse, fetal distress, active genital herpes, preeclampsia, some birth defects and some cases of multiple births (not always necessary). In these cases the benefits of a having a cesarean can greatly outweigh the risks. If you find yourself in a situation where cesarean is necessary, it doesn't have to be a negative experience. Knowing that you are making the safest choice for you and your baby is a great start. Some other tips for creating a positive experience when cesarean is neccesary can be found here.