After a woman discovers she's carrying a baby and survives the exhausting, often nauseating first trimester, it's time to start thinking about how the baby will make its way into the world. In today's birthing world, women in many countries have the option to choose the mode of delivery for their precious bundle, and they can go with a medicated delivery, a surgical birth, or a fully natural delivery.
With a plethora of research and classes that support taking the natural route, many women are choosing to give birth naturally despite all of the medical interventions available to ease their pain. Since natural birth can help mom with attachment and offers health benefits for both mom and baby, a natural birthing trend seems to be taking place.
However, just because we write it on the birth plan doesn't mean it's going to happen. Regardless of what we plan, our bodies ultimately call the shots, and we don't have as much control over the situation as we might like.
There are reasons a baby can't or won't come out naturally, and this can lead to a surgical birth whether a woman wants one or not. With the C-section rate on the rise in many countries, hitting near 33% in several place around the world, moms have every right to be concerned about being bullied into a C-section unnecessarily. It does happen.
However, it's also true that there are reasons a child will not come out the way mom planned, and in those situations we're extremely grateful for surgical births to help evict our child safely.
15 Breech Presentation
Ideally, a child should be in a head down position for delivery. This allows the head to come out first, and that eliminates many problems that can occur for a baby during labor, and it also makes the experience much easier on mom.
Unfortunately, some babies choose not to position themselves in a head down direction. Others simply can't maneuver into the proper position because of issues in the womb. When these babies instead present bottom or feet first, they are said to be breech.
Breech deliveries present specific challenges, and they increase the risks of injury to the baby and the mother. While some doctors will still let a mom attempt a breech delivery, many will not saying they would rather mom deliver in the controlled setting of an operating room than have her end up there when the baby is unable to come out. Because cord prolapse is also a potentially fatal problem when babies are breech, doctors are often reluctant to let mom try this type of birth naturally.
14 Posterior Presentation
When it comes to babies, we don’t want them sunny side up. A child whose face is facing mom's back is in a better position for delivery than a child whose face is facing mom's front. Though posterior, also called cephalic posterior or occiput posterior, natural births are possible, a baby in this position will likely cause mom much more pain and may not be able to make it through the birth canal as easily.
Women whose babies are posterior have a higher chance of needing forceps or a vacuum to assist in delivery since the position of the baby's head does not make descending into the birth canal ideal. They are also much more likely to receive a C-section, and some studies even show that postpartum hemorrhage is more common for mom's who deliver their babies in a posterior position.
While natural labor is still possible, it won't be as easy to achieve, and a mom whose baby goes posterior may end up in the OR instead of the cushy birthing room.
13 Mom In The Wrong Position
A baby's position is not the only one to consider during birth. Women who labor on their backs and who aren't allowed to move around freely during labor are at a greater risk of not being able to have their child naturally.
Though research shows that over 50% of women birth on their backs, typically with their feet harnessed in stirrups, research also shows that this is not the most effective way to give birth. With mom on her back, gravity is working against her, and the baby does not have as much room to get in the right position to exit the womb. Mom's pelvis is also wider when she is squatting or on her hands and knees, and this wideness offers the baby an easier departure.
Because many doctors don't want mom to labor for more than a certain amount of hours, putting her on her back could slow down her progress and therefore land her in an operating room.
12 Macrosomic Baby
Macrosomia occurs when a baby weighs more than they are expected to, coming in at over 8 pounds, 13 ounces, just under than nine pound mark. Macrosomia is more likely if mom has gestational diabetes, gained too much pregnancy weight, or is carrying a boy. There are other risk facts, but macrosomia almost always leads to one thing: a harder birth.
If a baby is too large to fit through mom's birth canal, the baby will become lodged and unable to proceed. That's one major reason that babies who are too large usually need help, either by the use of forceps, a vacuum, or a C-section. Babies who weigh too much may also experience injuries on the way out of the womb, ranging from minor to potentially fatal.
Many doctors will tell mom to avoid labor if her baby is measuring very large. If she does labor, they will keep a close eye on her and intervene early if she or the baby start suffering from the effects of the baby's size.
11 Narrow Pelvis
Cephalopelvic disproportion(CPD) is a condition where the baby cannot, despite mom's best efforts, fit through her pelvis. It's a matter of logistics; her hips just aren't big enough. Though cases of cephalopelvic disproportion are rare, they do occur.
Though the pelvis is made to loosen and widen to accommodate a baby, for some women these changes don't occur. These women truly suffer from cephalopelvic disproportion and may not know about it until they are in labor. That's because position changes and the movement of both baby and mom's body can help usher the little one out. If this doesn't occur and labor stalls due to the size of mom's pelvis, she has CPD.
CPD will lead to a C-section since there is no other way to retrieve a child from the womb.
10 No Dilation
Failure to progress, a condition where mom goes over a certain amount of hours in labor and still has no baby to show for it, can lead to derailed birth plans. When mom fails to progress, her cervix doesn't open the way it should and the baby can't get out. Some doctors measure failure to progress by how many centimeters mom dilates in an hour.
The trick about diagnosing failure to progress is that every woman is different. Our bodies respond and react to labor differently, and while one woman may dilate right on a doctor's ideal schedule, others may labor for hours without much dilation only to dilate quickly all at once.
When true failure to progress occurs and the possibility of prolonged labor is looming or has already arrived, a doctor may advise mom to have a C-section to ensure the safest delivery possible.
9 Previous C-sections
Once a C-section always a C-section is no longer true for many women. The option to have a vaginal birth after C-section(VBAC) is available for women who are good candidates, but much depends on a woman's previous C-section and her doctor.
If a woman's previous incision was a low, horizontal one, she may be a good candidate for VBAC. However, if it was a vertical scar, those rarely used unless there is an emergency situation, it's unlikely she will be able to VBAC. A vertical incision increases the risk of uterine rupture and a host of other complications.
A woman who wants to VBAC will also have to make sure her doctor is on board and that she delivers at a VBAC-friendly hospital. Because of the slight but increased risks of complications during a VBAC, some hospitals and doctors shy away from them and instead force mom to have a repeat C-section.
8 Placenta Previa
A diagnosis of placenta previa can be the end of mom's hope for a vaginal delivery. Depending on the severity of the situation, the occurrence of placenta previa can mean a C-section, no questions asked.
Placenta previa occurs when the placenta implants too low in mom's uterus, in some cases actually covering the entire cervix. Since the baby needs to move through the cervix to make it out of the womb, a complete previa means a C-section is the only way. Partial previas, where only part of the cervix is covered, are also usually handled by C-section. For women with only marginal coverage, some doctors will allow an attempt at a natural birth.
Though some women are at higher risk for placenta previa, such as women who have already had C-sections or those pregnant with multiples, it's not possible to predict who will be affected. When it occurs, mom has to reassess her plans for birth.
7 Prolapsed Cord
One of the most severe complications for the baby that mom can suffer during labor is a prolapsed cord. The umbilical cord, which the baby needs to survive in the womb, sometimes comes out before the baby, dropping through the cervix prior to delivery. When this occurs, it's likely that the cord will be compressed during labor, and that can cause health problems for the baby, including death.
Though some doctors may just monitor the baby's heart rate and take a watch closely and see approach, others want to evict the baby immediately via C-section. What occurs will depend on mom's unique situation and her doctor's comfort level in dealing with the situation.
In a prolapsed cord situation, a C-section is often the safest option. Though it can be disappointing to deal with this anomaly, access to C-sections can save babies when this occurs.
6 Birth With Multiples
While having twins or more can be exciting, it can mess with the birth plan in a big way. If mom is carrying triplets or beyond, she will almost certainly be signed up for a scheduled C-section due to the added risks of birthing that many babies. If mom is only carrying twins, she might have a chance of birthing naturally.
With twins, everything that needs to go right for one baby to be born naturally is multiplied by two. That means the baby presenting first needs to be head down, and it's preferable if both are. Some doctors will let a mom labor even when the baby coming out last is breech, but there are risks. If the twins are sharing a placenta, this adds complications due to problems that can occur during labor, such as twin-to-twin transfusion syndrome.
Women carrying twins are more likely to end up with a C-section, so it's important to go in with that in mind.
5 Umbilical Cord Issues
The umbilical cord is vital to a child's health, and besides being prolapsed, there are other issues that can occur with the cord that require immediate attention. If a cord is too long or too short, a child may have problems during labor, and these can lead to a C-section.
If a cord is wrapped around a baby's neck too tightly or one gets kinked or knotted during pregnancy or labor, mom may not be able to deliver naturally. Because a kinked cord can cut off oxygen supply to the baby and a cord around the neck can serve as a noose, doctors will advise mom to have a C-section so the baby can be removed with less chance of injury.
While not every umbilical cord issue results in a C-section, many do, and doctors may not know there is a problem until mom is in labor. Though it's hard to change birth plans after the process has already started, it can be necessary for the safety of the baby.
4 Obstructed Labor
Obstructed labor occurs when mom is in active labor, but despite contractions the baby is not coming out. For some reason, the child is blocked and can't make it out. Because obstructed labor can be extremely dangerous for both mom and baby, C-sections are usually performed as soon as a doctor diagnoses this problem.
Obstructed labor happens for a variety of reason, and teenage girls whose bodies aren't finished developing and women who are malnourished are at risk. If a woman's hips are too small or the baby is too big, that can lead to obstructed labor, as can a baby who is in the wrong position.
When the active stage of labor has gone on for more than 12 hours, not only will mom be tired but her doctor will be concerned. Due to the chances of the baby losing oxygen or mom dealing with uterine rupture, doctors will often require a surgical delivery.
3 Mom's Fear Of Stalling Labor
Most moms can tell anyone that fear is a big part of labor. While we are ready to meet our children, thinking about what we have to go through to do so can be difficult since there is so much pain involved. Tocophobia, a fear of labor, has even kept some women from getting pregnant. They wanted to avoid birth so much that they avoided having children altogether.
Though most women don't suffer the extremes of tocophobia, fear can still play a role in their birth experience. Some even believe fear can stall labor and that mom's emotional state may cause her birth plans to derail.
Hormones play a big role in labor, and when mom fails to progress, there are theories that fear might be the reason. The only way to deal with the pain is to go through it and come out the other side, proving to ourselves that we can overcome the fear. It's not easy but a good birthing partner or doula can help.
2 Induced Too Early
Inducing labor before necessary for non-medical reasons has become common practice in the medical community. Doctors will tell a woman she can't go past a certain number of weeks because that's his policy, and her individual situation will not be taken into consideration.
Some women agree to inductions because of convenience or because they are so sick of being pregnant, but research shows that inductions can absolutely derail a natural birthing plan. In fact, the risk of C-section increases by over 60% when a woman is induced.
Letting mom start labor on her own unless there is a medical reason not to is a sound idea because it's evidence her body is actually ready to birth. Though doctors can force Pitocin and other drugs to try to make mom labor, if her body's not ready, it will likely be a fail. For many women, that means a surgical birth instead of the natural one they wanted.
1 Introduction Of The Epidural
At least half of the women in the United States receive an epidural for pain management. Though some go in hoping to deliver without drugs, some women find they need the rest or want the respite from pain after hours of labor. While the epidural can be amazing for allowing mom to experience less pain, it can add complications to her finishing a vaginal delivery.
Once the epidural is administered, mom's movement is limited. Since the lower half of her body will be numb, she will need to stay in bed instead of walk around. She won't be able to squat or change positions, and this can slow down labor.
Some researchers also theorize that the epidural itself can slow down labor, while others believe that the IV fluids mixed with the epidural mess up the balance in mom's body and slow down the process. Either way, women with epidurals sometimes have a harder time during the pushing phase, and if they can't push effectively due to lack of feeling, they will end up in the OR.
Resources: Parenting.com, Americanpregnancy.org, Whattoexpect.com, Babycenter.com, Evidencebasedbirth.com