I’m part of a group of women I call the “Cesarean Sisterhood.” For various reasons, and in consultation with our respective doctors, we each made the decision to have a C-section birth.
In my case, my stubborn second son insisted there was no way he was entering the world head first. So, he put his foot down—literally—as I was approaching the 38th week of pregnancy. I don’t know if his toenails caused my waters to break, but there was no turning back. Within hours, a C-section delivery was performed and that bundle of joy made our family complete.
I used to think the Cesarean Sisterhood was an exclusive group. But I recently learned that one in three U.S. births happen by C-section—a rate that has risen dramatically over the past few decades. I wondered why this was the case, and what could be done about it.
Written by Ann Metz on behalf of Tennova Healthcare
To help me answer these questions and more, I contacted Brittany Stofko, D.O., an obstetrician and gynecologist with Tennova Healthcare. Dr. Stofko delivers babies at Tennova Healthcare’s Physicians Regional Medical Center in Knoxville.
“There are many good reasons why a C-section is performed, ranging from maternal medical conditions to concerns for the baby, such as cases when the umbilical cord becomes compressed, or fetal monitoring detects an abnormal heart rate,” Dr. Stofko says. “Sometimes, a very large baby or breech presentation will also indicate the necessity for a C-section delivery. In the case of a multiple pregnancy, the likelihood of having a cesarean birth also increases in relation to the number of babies a woman is carrying.”
The course of childbirth is not something that anyone can completely control. In some situations, performing a C-section is the right choice. However, the American College of Obstetricians and Gynecologists (ACOG) warns against the overuse of some common interventions, which may lead to C-sections.
Here are three things you might want to think twice about during your pregnancy:
A Planned Early Delivery
Some babies do arrive sooner than expected and certain complications during pregnancy, such as problems with the placenta or chronic high blood pressure, can make an early delivery the safest option.
“However, speeding up the birth of a healthy baby—even by a couple days—is rarely a good idea,” Dr. Stofko says. “An elective induction carries several risks for mother and baby. It also increases your odds of having a cesarean birth.”
In fact, a 2011 study found that women who have their labor induced (with the drug Pitocin, for example) without a recognized indication were 67 percent more likely to have a C-section, and their babies were 64 percent more likely to spend time in a neonatal intensive care unit, compared with women allowed to go into labor on their own.
“There is a greater risk of complications associated with births prior to 39 weeks,” Dr. Stofko says. “And waiting to deliver until 39 weeks allows for better growth and development of vital organs, such as the brain, lungs and liver.”
That’s why Tennova Healthcare is part of the Healthy Tennessee Babies Are Worth the Wait initiative, which is aimed at increasing awareness of the benefits of full-term delivery. The childbirth centers at both Physicians Regional Medical Center and Turkey Creek Medical Center have adopted a strict policy that prohibits early elective deliveries before 39 weeks—unless there is clear medical risk to the mother or baby.
Speeding Up Labor
Research indicates that labor actually progresses more slowly than previously thought. That means many women may need a little more time to labor and deliver vaginally instead of moving so quickly to induction methods or a C-section delivery.
“Allowing women with low-risk pregnancies to spend adequate time in the early stage of labor—before introducing any induction methods—may avoid unnecessary cesareans,” Dr. Stofko says. “This includes considering cervical dilation of six centimeters as the start of the active phase of labor, instead of four centimeters; and allowing women to push for at least two hours if they have delivered previously, and three hours if it’s their first delivery.”
Dr. Stofko points out that those women who go into labor naturally can usually spend the early portion of time at home, moving around as they feel most comfortable. “Accelerating labor by rupturing the amniotic membranes—or breaking the waters—to strengthen contractions and shorten labor can cause rare but serious complications.
“In addition to C-sections, inducing or speeding up labor may lead to other interventions, including epidurals for pain relief, and deliveries with the use of forceps or vacuums,” she says.
An Automatic Second C-Section
It no longer holds true that “once a C-section always a C-section.” Many women who have had a C-section birth before are able to safely deliver vaginally, according to ACOG.
“The decision depends on the type of incision used in the previous cesarean delivery, the number of previous cesarean births, whether you have any medical conditions that make a vaginal delivery risky, and the type of hospital in which you have your baby, as well as other factors,” Dr. Stofko says.
“Just because your first baby was delivered by C-section doesn’t mean your second baby has to be, too,” she says. “You should talk to your doctor or nurse midwife about your options. Find out if your healthcare provider and hospital are willing to try VBAC (vaginal birth after cesarean). Let them know you understand that your baby will be monitored during labor, and find out what they will do if an emergency C-section becomes necessary.”
If you end up giving birth by C-section, don’t be disappointed. The goal should always be a healthy pregnancy and a safe delivery—for both you and your baby.
Need an OB/GYN or nurse midwife? For a referral to a women’s care specialist, or to learn more about childbirth services at Tennova Healthcare, call 1-855-TENNOVA (836-6682) or visit TennovaMedicalGroup.com.
