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To C-Section Or Not: 15 Must-Knows When Deciding

Many moms-to-be worry about delivery almost as soon as they get pregnant. And it's justified. That day is very important, not just because it is the day when she will meet her baby but because the delivery impacts the health of the baby and the mother.

Many women automatically frown on C-sections these days, especially since the all-natural trend has grown. But at times, they are needed to save either the mother or the baby — or both. The procedure dates back to ancient Rome, and some say that the name is a nod to Julius Caesar, who was born via C-section.

At the outset, the procedure was used to save the baby but the mother did not survive. But now, it has the potential to save all involved. But there are risks.

Because many times the need for a C-section arises in an emergency, mothers-to-be should investigate the pros and cons while they are pregnant so they will understand more about their doctor's recommendation.

Here are 15 must-knows when decided to get a C-section or not.

15 The Statistics

One of the reasons that C-sections have gotten a bad rap in the United States is because of their prevalence. The use has been on the rise since the 1920s, to the point where about one out of every three deliveries these days is by Cesarean.

Those statistics vary by hospital and doctor, which makes some people suspicious, probably rightly so, that some doctors perform C-sections out of convenience.  The C-section rate in the United States is much higher than in many other parts of the world, while the infant mortality rate is also much higher, although countries with better health care systems can have lower C-section rates and higher mortality rates.

It is important to note that only 10 percent of C-sections are truly elective, and that healthcare leaders have worked to reduce that rate in recent years. Still, there are many medical reasons that a C-section could be necessary, so talk to your doctor.

14 Planning Ahead

There are times when a mother will know well ahead of time that her doctor recommends a C-section. There are several factors that can determine this, including if the mother has certain medical conditions that raise the risks of the delivery like heart disease or kidney disease.

Also, some sexually transmitted diseases can be passed to the baby if the birth goes through the birth canal, so moms who are HIV-positive or have an active herpes infection will likely have a recommendation for a C-section.

Obstructions to the baby's path out can also call for a C-section, such as placenta previa, where the placenta covers the cervix. A mom who has uterine fibroids likely will be looking toward a C-section as well.

Baby's health is also very important, and doctors will weigh that into their recommendation as well. For example, a baby with spina bifida could run the risk of paralysis in a vaginal birth, or a baby with a heart defect could have to work too hard during a vaginal delivery. These could lead to a recommendation for a C-section as well.

13 Elective Risks

There are several reasons that women ask about elective cesareans. Some are scared to go through a vaginal delivery — and a fear that has a woman considering putting herself under the knife is nothing to sneeze about; it should be taken seriously. And women who go through vaginal deliveries can experience their own complications, including bladder problems and sexual issues.

Some women think that choosing to have a subsequent cesarean can be considered elective, if the mother goes into the procedure without any of the complications that caused the first to go to surgery. However, many doctors are reluctant to allow a woman to try for a vaginal delivery after cesarean because of the risk of a tear at the previous incision site.

Ever since celebrities became tagged with the idea of being "too posh to push," the idea has gotten a bad rap. But both the doctor and the patient need to get to the root of the issue and consider it carefully before making a delivery decision.

12 Size Matters

One of the most common complaints about C-sections is when a doctor recommends it because of the size of the baby. While the average baby is 7 pounds, a baby is considered to have macrosomia at 8 pounds 13 ounces, and any baby over 9 pounds 15 ounces is at risk for health issues.

Some women tend to have large babies for no known reason, although large babies can run in families. Other times it happens when a woman gains more weight than is recommended or if she has uncontrolled or undiagnosed gestational diabetes. And some of those babies are born safely without the mom even knowing that she is carrying a 10-pounder until the weigh in.

However, sometimes those babies get stuck in the birth canal. The mom is more likely to suffer tears, if she is able to finally push the baby out, but the biggest risk is that the baby could suffer a birth injury such as shoulder dystocia, where the shoulder gets stuck and the baby ends up with limited use of an arm.

That isn't a risk some women are willing to make, although some go through labor and try to push the baby out for a couple of hours before making the decision to do an emergency C-section.

11 Breech Baby

Another common reason for a planned C-section is when the baby is breech. Newborns' heads are malleable and change shape to get through the birth canal, but if they are coming out feet or bottom first, it's more likely they will get stuck.

About three percent of babies are breech at the time of delivery — either with their feet hanging down or with their bottom pointed down. Some babies don't flip to the correct position until a few days before birth, and a doctor can try a few things to get the baby into the correct position.

The doctor will try an external cephalic version, which involves pushing on the mother's stomach, and the mother can try pelvic tilts or even putting music or frozen veggies on her tummy to try to get the baby to turn.

Some women try for a vaginal delivery of her breech baby, although she has to talk to her doctor about whether it is safe, as there are a number of complications that can arise. Because of that nearly 90 percent of breech babies are delivered by C-section.

10 Multiples

Sometimes twins can be delivered vaginally, but triplets or higher more than likely require a C-section. There are lots of factors that determine whether a vaginal delivery is safe, including the health of the babies, and if they have reached at least 2,000 grams, or more than 4 pounds.

During multiple pregnancies, the uterus gets stretched, and sometimes it can't contract enough to dilate the cervix, causing long and difficult labors. The position of the babies is also key. Some twins are conjoined, which often makes a vaginal delivery impossible. Sometimes the babies get locked together, and often one of the babies is breech. A mom can attempt a vaginal delivery if the first baby is head down and the second is breech because the twin often flips after the first is born, but if the first is breech, there likely isn't room for it to flip.

One of the biggest dangers of delivering twins that share one amniotic sac is the likelihood that the umbilical cords can get tangled. If their oxygen supply is cut off, the results can be devastating, so most monoamniotic twins are delivered via C-section.

9 Cord Conflict

Speaking of the umbilical cord, it also can sway a delivery decision in a singleton pregnancy. The cord connects the mother to baby and provides the oxygen while the baby is in the womb. Cutting it off for any period of time can mean brain damage, and if that time is too long, even death. That is why doctors are always quick to check the cord position as much as they can during delivery.

If the baby's amniotic sac ruptures early — especially before the onset of labor contractions — there is a greater likelihood that the cord will dip into the cervix. Once the baby's head lodges into the cervix, there is a lot of pressure and not much room, so that could mean that the cord gets cut off and the oxygen supply slows. If the doctor feels the cord before the baby, he is likely to recommend mom be rushed into the operating room.

8 Fetal Distress

One of the most common reasons for an emergency C-section is fetal distress. That is when a doctor discovers that the baby is not faring well through labor. In the hospital, many babies are monitored through devices placed on the mother's belly. It can either be continual or intermittent, but the signals let the doctors and nurses know the baby's heartbeat.

It's somewhat common for the baby's heartrate to change a little during contractions, but a drastic change could indicate that the baby is having trouble dealing with the stress of labor. A big dip in the heart rate often causes the doctor to recommending getting to the operating room.

First of all, let us reassure you that most doctors here have a genuine concern for the baby. However, many doctors disagree as to the point where a baby's life is at risk. Sometimes pitocin can cause a baby's heart rate to slow, but sometimes it can be something else like a placental abruption, and there is little way for the doctor to know which until there is little time to save the baby or the mother.

It can be scary, but most babies who go into fetal distress are delivered healthy, especially if the delivery can happen quickly.

7 Evolutionary Issue

According to new scientific research, the implications of a C-section could be felt long after the birth — as in, generations later. Whereas mothers with smaller hips may have not been able to pass on their genes in the past because they died in childbirth, the Cesarean section has allowed for women to survive through childbirth a lot more than they did a couple of centuries ago. And the new research shows that has evolutionary implications.

The use of C-sections, the scientists say, have allowed for a 10 to 20 percent increase in the difference between a baby's size and the female pelvis. In other words, babies are getting bigger at birth compared to the place that they have to squeeze through.

“Evolution is happening even in our modern society,” said the study's  lead author Philipp Mitteroecker, an assistant professor with the University of Vienna, Austria in a CBS News report.

It's an interesting idea, but it's probably not too relevant to the decision a mother has to make for her own child. She has to worry about the more immediate health effects, not the long-term ones.

6 Baby Breathing Problems

Most babies born via C-section are born healthy — or as healthy as possible considering any conditions that caused the C-section to be recommended in the first place. However, some babies struggle to breathe initially. It's called transient tachypnea of the newborn, and it involves having fluid in the lungs.

While in the womb, the baby gets oxygen through the umbilical cord, but he inhales and ingests amniotic fluid throughout the pregnancy. The trip through the birth canal compresses the baby's chest and help to push out a lot of that amniotic fluid, but if a baby is born via C-section, he doesn't have that benefit. About 20 percent of babies born via C-section need some help breathing initially. But they usually recover quickly and are fine within a couple of days. For the most part, it's a short-term issue that is much less serious than what could come if a vaginal delivery goes wrong. Anyone concerned about the issue should talk to their doctor about the risks and rewards.

5 Recovery

It is true that postpartum recovery can be tougher for a C-section mom. It takes longer to go home from the hospital, and it can take weeks to feel better. The C-section mom feels the same issues as a mom who goes through a vaginal delivery, plus a few other problems. Like every new mother, she will feel fatigue, although the operation can make that even worse, and she will go through lochia, or discharge as all of the blood is expelled from the uterus, along with breast engorgement due to the hormones of giving birth. She will also have after pains as her uterus contracts to its pre-pregnancy size. If the cesarean was an emergency, should could also have some perineal pain.

On top of those normal postpartum pains, a C-section mom will likely be very sore at her incision, and she needs to keep an eye out for infection. She will want to wear loose clothing and be careful to not get constipated or gassy because that could put pressure on the incision. Some women also take a few days to deal with the medication that they have during delivery, so that can be a problem as well.

The scar will heal in time, and many women proudly consider a badge of motherhood.

4 Repeat or VBAC

In recent years, more doctors have been willing to treat a woman who tries for a vaginal delivery after cesarean. In the past, more worried that there would be complications from the incision, so they were reluctant to allow the attempt. By the way, we are using the word attempt because many VBACs end up in the operating room after all.

A woman who has had a cesarean who is in good health and whose baby is also in good health could be encouraged to try for a vaginal delivery, especially if she would like to have more children because repeated C-sections (after four) can be dangerous. But many times the same factors that caused the woman to go to the operating room can return. If labor doesn't progress quickly or if a woman has a small pelvis, she may labor for hours only to end up back in the operating room. It may be worth a try, but a woman should be prepared for either option.

3 Gentle C-section

In many hospitals, C-sections are no longer the sterile, cold procedure they were in the past. (Well, actually, we hope they are sterile, as in free of germs, but not free of warmth.) The trend is called a "family-centered" or "gentle" C-section. It involves lowering the screen to allow a mom and dad to watch the delivery, and the procedure may be slowed down to allow the baby's chest to be squeezed on the way through the incision, which helps clear the lungs of fluid.

Most importantly, it allows the baby to placed right on the mother for kangaroo care (as long as the baby is healthy). The baby may be able to stay with the mother for the rest of the surgery and even into the recovery room instead of being whisked away to be cleaned and cared for in a separate room. Again, this is only in the case where the baby is healthy and does not need a doctor's attention.

The benefits are a better bonding experience, a more successful start to breastfeeding and a lower risk of postpartum depression. So a mom-to-be who is concerned about her C-section should talk to her doctor to see if any of the accommodations can be made for her procedure.

2 Breastfeeding Impact

For women who are upset about missing out on an all-natural labor and delivery, let us assure you that it won't hurt your ability to feed your baby naturally. The belief that a woman who has a C-section can't breastfeed is a myth, but there are considerations that a mother-to-be needs to know about so she can have success.

First of all, there is research that shows that breastfeeding in the first hour of a newborn's life helps ensure success. But that golden hour isn't possible for all C-section moms, and that is OK. Try to do it as soon as possible, and ask for help if you are still feeling the effects of the epidural. Hospital also have pumps for moms who have to wait to breastfeed.

Women who go through surgery are given painkillers and antibiotics for a few days afterward, but those medications should not impact the baby other than to maybe make her a little sleepy. Also, a lactation consultant may be able to help a new mom figure out the best hold for breastfeeding that avoids irritating the incision spot. Be sure to ask for help; it's a good idea for any new mom.

1 Birth Regret

Whether you've had a chance to get used to the idea of a C-section for months or if it comes up in an emergency, some women go through birth regret after the delivery. In a society where women put a premium on a "natural" birth, some women feel like they haven't really experienced birth if the baby comes out through a surgical procedure. They feel less capable and as if their bodies failed them.

Birth regret also happens to women who go through a vaginal delivery, but every time it happens, it's a tragedy. Many times the decision to have a C-section is the bravest thing a woman can do. She puts her own body on the line to make sure her baby is as healthy as possible, and sometimes she is also saving her own life — the life of her child's mother.

Birth regret can make postpartum depression worse, so a new mom should talk to her doctor about it. She should get therapy or medication, if necessary, so she can be as healthy physically and mentally to be there for her baby as possible.

Sources: What to Expect, WebMD, FitPregnancy, The Bump, Baby Center, Parents

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