Singer Maren Morris recently shared with People Magazine her experience having an unexpected c-section. She said,
“I labored for 30 hours, wanted to do it naturally, but I stopped having contractions and it was just time to call it and get him out safely,” says Morris. “So I just wish I had done a better job at preparing myself for the shock of a c-section, because the postpartum of a c-section is so brutal.”https://isthisnormal.littlespoon.com/maren-morris-c-section-recovery-0820/
I sympathized with her experience as someone who performs c-sections. Very commonly pregnant ladies will ask me during their prenatal visits, “Doc, how will I know if I need a c-section?” My response?
You usually won’t know you need a c-section until you go into labor.
So what do you need to do to prevent or prepare for a possible c-section? That’s what I’ll share in this post.
In this post we will discuss:
- Power, Passenger and Passage, the Path to a Vaginal Delivery
- How can I reduce my chances of needing a c-section?
- What are some myths about c-section? (Let’s examine Maren Morris’s story)
- What is a Gentle C-section?
- What about VBAC?
- What about twins and other multiples?
- If I have Herpes, will I need a c-section?
- Can I ask for a c-section even if I have no medical need for one?
A cesarean delivery, or c-section, is a surgical delivery of an infant through an abdominal incision. This is in contrast to delivery through the vagina. In the United States, about 32% of babies are born via c-section, with some statistical variations by state.
Reasons for c-section are numerous.
I usually break down baby delivery into three parts. Power, Passenger and Passage
Uterine contractions need to be strong enough and frequent enough for a baby to be forced out of the uterus. Many people go into labor and initially the contractions are mild. Over time, sometimes hours to days, those contractions will increase in frequency and intensity, transitional a person from latent to active labor.
Eventually these muscle contractions of the uterus should be enough to eject the baby. If they aren’t sometimes Pitocin is required to make the contractions stronger and more frequent. I needed Pitocin for all 3 of my labors. Click here to read one of my birth stories.
First, the baby needs to be head down rather that breech (feet down). The baby also needs to tolerate labor. Every time the uterus contracts, the blood supply to the placenta is restricted for about 30 seconds to a minute. A fetus in the uterus needs to have enough oxygen flowing to allow for that intermittent interruption in oxygen flow.
If either the placenta is not functioning well, possibly due to being older or too small or because of hypertension, diabetes, or preeclampsia, baby may not be able to get enough oxygen to sustain repeated contractions for hours on end. The fetal heart beat monitor will show signs of that.
For a baby to come out of the vagina, the pelvis has to be large enough to allow that transport. Actually, the passenger comes into play here too because the pelvis needs to large enough and the baby has to be small enough to fit.
The cervix opening (which is the opening of the uterus) also has to stretch and mold from the size of a pin to the size to 10 centimeters, the size of a grapefruit. If the cervix can’t enlarge to 10 centimeters or the baby can’t fit through the pelvis, that baby can’t come out.
How can I reduce my chances of needing a c-section?
First, you need to understand why some women end up needing a c-section. Some risk factors for needing a c-section are:
- Age greater than 25 (messed up right?)
- Being obese- BMI greater than 30
- Diabetes diagnosed before or during pregnancy
- Baby size extremes: Size estimates greater than 4 kilograms (8.8 lb) or less than 2.5 kilograms (5.5 lb)
- Having previously had a c-section (We’ll talk more about this in the VBAC section)
Many of those risk factors are unfortunately out of your control, but regular exercise if deemed safe by your doctor, maintaining a healthy weight pre-pregnancy and, if diabetic, keeping good control of your blood sugars will be super helpful.
When it comes to labor, the power, passenger and passage need to work together to get the baby out. If the power can’t be increased enough to lead to cervical dilation, or if the baby won’t fit through the pelvis or tolerate labor, or if an infection develops and a vaginal delivery is not in the near future, a c-section may be necessary. These are only a few reasons.
What are some myths about c-section? (Let’s examine Maren Morris’s Story)
While I sympathized with Maren’s story, I disagreed with some of the things she said happened to her because of her c-section. She said that her husband,
“would have to lift [her] out of bed” before she could do so safely herself. “You can’t use any of your abdominal muscles,” she says. “I had to army crawl to get out of bed to use the bathroom in the middle of the night.”https://isthisnormal.littlespoon.com/maren-morris-c-section-recovery-0820/
I am not challenging the validity of her story. That was her truth. HOWEVER, I will say that most women can get themselves in and out of the bed and walk to the bathroom, through the halls of the hospital, up and down stairs at home, etc. I have NEVER seen someone army crawl on the floor after a c-section, and many a partner are tending to the baby while the new mom makes her way, slowly and carefully, wherever she needs to go.
We don’t cut the abdominal muscles during a c-section. We separate them like curtains to delivery the baby. When the baby is out and the uterus is closed, they go back to their normal position without any assistance. Although we recommend new moms not resume exercise until 6 weeks or when cleared by your doctor, these muscles aren’t damaged. Everything around them needs to heal.
Another thing she said in the article:
“And you’re also wanting to hold your baby and breastfeed and pump and all this other s—, so that was crazy,”
I do want to highlight one super important thing Maren said:
“All that mattered was that he got here safely.”
What is a Gentle C-section?
I’ll be honest, I didn’t really know before writing this article, but I was pleased to see with my reading about it that it is basically all the things we already do, at least at my hospital, Prentice Women’s Hospital.
The idea of a Gentle C-section appears to be one that more closely mimics the birthing experience of a vaginal delivery. Women’s arms aren’t strapped down. EKG leads are placed more to the side of women’s chest so as to allow for baby to lay for skin-to-skin. Warm blankets are provided.
Some hospitals even offer clear drapes so that the c-section can be witnessed. I have mixed feelings about the clear drape because everyone isn’t cut out to see surgery as it is happening. I even like to play music in the operating room, mother’s choice of course.
Ask your provider if you can do skin-to-skin in the operating room if you desire, in the event that you end up needing a c-section.
What about VBAC?
VBAC stands for Vaginal Birth after Cesarean. The term we clinically use more often is actually TOLAC, which stands for Trial of Labor after Cesarean section. A person can attempt a vaginal delivery after one c-section if it was done the standard Low Transverse fashion. If a person has a “classical” cesarean section, they can’t labor after that.
VBAC/TOLAC increases a persons risk for something called uterine rupture, which is a complication that can be life-threatening for mom and baby. Thankfully that risk is very low in most circumstances. The decision to try a TOLAC vs opting for a repeat c-section is one that should be discussed between you and your doctor.
Your doctor may even use a TOLAC success calculator to help to guide their advice to you. The calculators give a probability of successful vaginal delivery based on factors like age, delivery history, BMI etc. Ultimately this is a decision between a patient and their provider.
What about twins and other multiples?
Many twins are delivered via c-section for reasons like position, if they share an amniotic fluid sac or placenta. Some twins can be born vaginally depending on the position of the twins, size and mother’s medical history. There are always risks with twins that one twin will come out vaginally and the second will need to be delivered via c-section. This is another one that needs to be discussed with your provider, including risks, benefits, and alternatives for each choice.
If I have Herpes, will I need a c-section?
No. Not unless you have an active outbreak at the time of labor. If you have a history of herpes, you provider may ask you to take antiviral suppression like Valacyclovir twice daily in the final month of pregnancy to help reduce the chance of an outbreak during labor.
The highest risk of transmission of herpes to baby is if a baby is born through an active outbreak vaginally, especially if it is the first outbreak. This can be life-threatening for a newborn. If you are having pain or bumps in the vaginal or vulvar area toward the end of pregnancy, show the area to your provider. This information can be life-saving.
Can I ask for a c-section even if I have no medical need for one?
Yes, but their are risks. All c-sections come with three main risks.
- Risk of bleeding more that what would be expected with a vaginal delivery
- Risk of infection
- Risk of damage to surrounding organs like the bowel or bladder.
Also with each subsequent delivery, distorting scar tissue can increase risks for complications. The placenta can also adhere abnormally to a previous scar on the inside and cause something called placenta accreta. This severe condition can, in extreme cases, lead to the need for a hysterectomy. The risk for placenta accreta increases with each delivery, so ideally c-section would be avoided.
However, as long as a person understands the risks, benefits and alternatives of their decision, a c-section as a preferred delivery method, known as an elective c-section, is a reasonable route of delivery. All birth is natural.
I said, ALL BIRTH IS NATURAL
I had to say it again for the people in the back.
In conclusion, some c-sections are planned, some are emergent (like Serena Williams) and some come after long, arduous labor. Never be afraid to ask your provider to explain why you need or needed a c-section. Clarity and understanding are extremely important in my opinion. Hopefully, you gained some clarity from this article.
Thank you, all as always for reading. Please subscribe to join our email list and to be informed of future articles and information for all humans with vaginas. Also, comment below with topics you’d like to see us cover here at The Gyneco-bLogic.