Tuesday, May 21, 2013

Cesarean Section

Over the course of my pregnancy, I rarely thought about what the birth would be like or came up with a birth plan.  I was just to darn nervous that I would jinx something.  But starting around 28 weeks, my OBs would ask me how I planned to deliver and we would spend a little time discussing the merits of vaginal delivery vs cesarean section.  Most of my pregnancy I assumed that even if I did go into labor or have an induction there would still be a 50% chance of having a c-section (that was what my doctors quoted me for a twin pregnancy).  As the pregnancy progressed, I started to research vaginal delivery of twins especially since my daughter (Twin A) had been head down since like 24 weeks.  I almost went into labor spontaneously at 37 weeks, but when I didn't progress past 4 cm after 2 hours, we went home where my contractions immediately stopped (despite my best work on the exercise ball!!)  I pushed my doctors for an induction vs c-section at 38 weeks and so at 38 weeks, I arrived at the hospital for my induction.  As I was checking in, they asked me if I just wanted a c-section or try an induction.  An ultrasound revealed that my son (Twin B) had also turned head down, so we continued with my plan for induction.  I was very, VERY adamant that if at any time either of the babies showed any, ANY signs of distress that we would just go back for an immediate c-section.  My doctors were totally on-board with this plan.  When my labor stalled after 24 hours on pitocin for induction and magnesium for pre-eclampsia, after talking it over with CJ and my nurses and doctors, and after many tears, I asked for a c-section and within an hour, we were heading to the OR and 30 minutes later, I met my daughter and son.  I am beyond thankful to my OB for being very honest about that fact that I likely would not have progressed to fully dilated and even if I did my risk of tearing was incredibly high since I was so swollen.  I was kinda in a daze due to the magnesium, but my overall experience with the c-section was very positive and best of all my twins were here safe and sound.  The recovery was painful for the first week if I got behind on my pain medication and my milk didn't come in until postpartum day 5 (but that I might have been from the magnesium and it definitely wasn't from lack of nursing them!!), but after 2 weeks I was off all pain meds and I felt  great!!  Now, I have my c-section scar to remind me of how my twins entered the world and I think it is a beautiful reminder (which may sound weird, but I don't know exactly how best to explain it.)  So there you have my personal experience with a failed induction and c-section for the birth of my twins.

I come from a family of women who have had c-sections.  My mom had an emergency c-section with my twin sister and I with a classical incision and then had to have 2 repeat c-sections with my brother and sister. My twin sister had an urgent c-section with her first baby because on follow-up ultrasound her placenta looked awful at 36 weeks and her baby was breech.  She has since had 2 elective c-sections with my nephew and niece.  With each of her c-sections, her recovery time has gotten faster and pain less.  Seriously, after my nephew was born, my sister was up and walking around with us in the hospital and even went home a day early.  That about sums up my family's experience with c-sections.

As a doctor, I have experience with labor and delivery and have read some of the studies on c-section vs vaginal delivery.  Based on my personal experiences and my professional ones, I do not understand why people are so anti-cesarean.  I think we have cultivated this ideal of the natural childbirth has being the best and healthiest way to bring babies into the world and we have turned on cesarean deliveries as the evil twin with all these horrible side effects and dangers.  The reality seems to be (and the data seems to show) that cesarean deliveries under controlled situations are safe for mom and baby.  Vaginal deliveries also seem to be safe for mom and baby, but there are risks involved, serious risks, that I think we may forget about as we try to reach the ideal of a natural childbirth with a vaginal delivery.

I'm going to publish this post now for fear that I may not get back to it soon, but I'm going to do a literature search during my pumping breaks at work and try to come up with some data to support my ideas.  I'm not sure what the real reason for my post it, but I know how hard it can be to not reach that ideal of a vaginal delivery and the feelings of failure that are associated with it, but maybe, just maybe a cesarean section should not be thought of as the mom failing, but instead as mother bringing her baby or babies into the world in the safest way possible.

10 comments:

  1. I don't have anything against a c-section. If its the safest way to get my girls here then I'm all for it! I'd prefer a vaginal mainly to have the golden hour. I want to hold my babies right away, BF and snuggle them. I wish there was some way I could do this and get a c-section. I am nervous about attempting to vaginally deliver and the risks that come with doing that and twins. Too bad you can't get the best of both worlds. :)

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  2. I love this post!! I had a similar birth story as yours, but I felt like a disappointment for having to have a c-section. It was devastating for some reason at the time. 8 months later I wish I would have just scheduled the c-sec rather than go fwd with an induction. I'm looking fwd to reading any research you find.

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  3. It is wonderful to hear someone speak out positively for c-section birth. My sister experienced a failed induction earlier in the year which turned into a c-section. I know it has been hard for her emotionally because she had built up natural childbirth as the be all, end all. Thank you for this post!

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  4. I also want to thank you for your post. I had a c-section, the first one in the family as my mom had all her children vaginally and so did my sister and sister-in-law. Luckily for me, I didn't really care how I bring my baby into this world, as long as he is healthy. So, I wasn't stressed out when the "C" word was uttered. After a long labour, I tried to pushed him out for almost an hour before the decision was made to go with c-section as he was not handling me pushing very well nor was he even close enough to coming out (and I was both overdue and on picotin (sp?)). Now, everyone asking me if I will try to have a vaginal delivery with my next child (I am not even pregnant yet, and with IF who knows when that is going to happen), and when I say that I had enough with my first one and just want to go through c-section again, they look at me like I am crazy. My c-section experience, like yours was very positive, and I too look at my scar as a beautiful reminder of the birth of my son.

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  5. Hi from ICLW. Sometimes C-sections are the best options.

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  6. I think that is an incredibly healthy perspective and I'm glad you shared it. I think so many people someone become convinced that they 'failed' or missed out on a magical moment. The magical moment is the moment you hold the baby you've been dreaming of in your arms. I hope your perspective helps women struggling with that.

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  7. i agree with you that there are a lot of pressures put on Mom's about how they SHOULD do things when the decisions should always be about what is safest for the mom and baby. However, there is research that shows that babies born via cesarean have a different gut flora than those born via vaginal birth and that this has implications later in life, although i can't offhand remember what it changes.

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  8. I don't have a problem with C-sections in general but I do have a problem with unnecessary C-sections, which unfortunately is what a lot of C-sections are. The rate of C-sections for first time moms should not be 50%...that's just insane. I am however eternally grateful that C-sections exist to save the moms and babies who truly need them in emergency situations.

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  9. Hi, I'm stopping by from ICLW. Congratulations on the birth of your son and daughter. I guess all surgery is risky but then so is child birth in general. I guess finding the right choice for the mother is really the best option all round.

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  10. Congratulations on the birth of your twins. I had a semi-emergent c-section with my first (and second despite vbac plans) and then a scheduled c-section with my third. Frankly, I don't care how they got here...just that they got here healthy.

    Hope everything continues to go well for you.

    ICLW #30

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