Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Top 8 Ways to Have an Unnecessary Cesarean Section April 3, 2009

(Adapted from Top 7 Ways to Have an Unnecessary C-Section)

 

Happy April everyone!  As you may or may not be aware, the International Cesarean Awareness Network (ICAN) has declared April to be Cesarean Awareness Month.  In honor of this, I decided to share with you a website I recently found that I thought was pretty amusing. 

 

Blogger Esther Brady Crawford of faintstarlite.com recently wrote a post entitled “Top 7 Ways to Have an Unnecessary C-Section”.  Not only is it amusing (and perhaps a bit cynical) but it is also: 1) sad that it is so true and 2) very true.  I encourage you to read her original post since she gives her own hilarious explanations for each “pointer” but since I am a big research nerd, I have added my own comments to her original Top 7.  At the end of this post I have included an eighth “pointer” to the list to make it a Top 8.  Much of the research I cite in this post is from the book The Thinking Woman’s Guide to a Better Birth by Henci Goer.

 

So here it goes…

 

#7  Go the hospital in the early phases of labor.

          Crawford is just plain right-on with this one!  Too many obstetricians are quick to label a mom as having “dysfunctional labor” if she does not progress at least one centimeter an hour (for first time moms) or two centimeters and hour (for multiparous moms) immediately upon arriving to the hospital.  I have even had some doctors I work with take a call from a mom at home that “sounds like she is in labor” and turn around and tell the residents to “start her on pit as soon as she gets here.”  WHAT??!!  Pam England, CNM, MA writes in her book Birthing From Within, “One advantage to laboring in the privacy of your home, with one-on-one midwifery support, is that should a problem arise that requires medical support at the hospital, you will not wonder whether your labor problems were caused by routine, unnecessary, or ill-timed hospital interventions.”

 

#6  Don’t eat or drink during a long labor.

          Goer writes that dehydration and starvation caused by restricting food/drink intake during labor causes a woman not only considerable discomfort but can also lead to fever, prolonged labor, increased use of oxytocin (aka pitocin), instrumental delivery, and a non-reassuring fetal heart rate pattern/fetal distress.  And what can all of these lead to…that’s right…a cesarean section!  (Goer, 79-83)

 

#5  Get an amniotomy too soon.

          Amniotomy (or artificially “breaking the bag of waters”) too soon can lead to umbilical cord compression/fetal distress, abnormal fetal heart rate patterns, cord prolapse (a surgical emergency where the umbilical cord slips out into the birth canal before the baby’s head), increased likelihood of maternal infection and hence a “race against the clock” to get a woman “delivered” before 24 hours is up, and lastly, a greater chance that the baby get “stuck” in a posterior (back of head toward your back) or acynclitic (head tilted off to one side) position which can stall labor and make pushing at best, difficult and at worse, unsuccessful.    Bottom line, if it ain’t broke, leave it alone!  Not obeying that rule could lead you to an unnecessary cesarean!  (Goer, 99-104)

 

#4  Accept pitocin to induce or stimulate contractions.

          The use of oxytocin (pitocin) for labor augmentation (aka “revving up a slow labor”) or induction (aka artificially starting a labor that hasn’t started on its own) has its own risks.  Although oxytocin is quite effective at stimulating contractions, it often makes contractions stronger and longer than natural contractions, can cause too many contractions too close together (aka uterine tachysystole or hyperstimulation) which can lead to fetal distress, can double the chances of a baby being born in poor condition, and eventually can lead you to the operating room!  (Goer, 65)

 

#3  Request an epidural.

          Research has shown that epidurals 1) interfere with a mother’s natural release of labor hormones which can in turn (among other things) slow or stop her progress of labor, 2) increase her chances of needing pitocin augmentation for said slowed labor, 3) numb her pelvic floor muscles, which are important in guiding her baby’s head into a good position for birth , 4) can cause maternal fever than can be mistaken as a sign of infection, 5) can cause a significant drop in her blood pressure which can interfere with how much blood supply is getting to the baby and can lead to profoundly negative effects on the baby’s heart rate, 6) significantly impair in her ability to push her baby out effectively.  All of these side effects/risks, as research has shown can, and often does, lead to a cesarean section.  (See “Epidurals: risks and concerns for mother and baby” by Dr Sarah J. Buckley)

 

#2  Accept hospital staff’s comments on lack of progress without challenge.

          In my opinion, nothing is more detrimental to a woman’s labor progress and ultimately her birth experience than negativity in the labor room from labor & birth attendants, especially the people who are the “professionals” like obstetricians, midwives, and nurses.  As Marsden Wagner, MD, MS writes in his book Born in the USA, fear and anxiety stop labor.  And giving a woman the impression that she is “failing” can lead to a helpless and hopeless attitude and eventually a cascade of interventions that might very well lead to a cesarean section. 

 

#1 Just ask!

          Believe it or not, there are some OBGYNs out there that will agree to perform a cesarean section on a first time mom without medical indication.  Goer writes, “Popping up lately in the medical literature are arguments that women should be able to have first cesareans for the asking as well.  Again, this is presented as a freedom of choice issue.  But how much real freedom do women have in a culture that portrays labor as torture and C-sections as a ‘no muss, no fuss’ option?”  Goer states that the obstetric belief that choosing between a cesarean and vaginal birth is like choosing “between chocolate and vanilla” is really about six things: money, impatience, convenience, peer pressure, hospital culture, and defensive medicine.  What I find even more disturbing than this, however, is that women who do desire to avoid a cesarean and plan for a vaginal birth after a cesarean (VBAC) are finding themselves with less choice and opportunity to do so in more and more communities around this country as more and more obstetricians are refusing to attend VBACs and hospitals are either banning or placing de facto bans on VBACs.  

 

And lastly here is my own addition…number 8!

 

#8  Agree to a labor induction without medical indication.

          Induction of labor comes with risks and the BIGGEST risk is the risk of cesarean section.  When induction of labor is done for a medical reason, either related to mom or baby, and the risks of continuing the pregnancy are greater than the risks of induction, then this is the only time when labor induction is appropriate and warranted.  But when a woman agrees to a labor induction without any medical reason, then she is putting herself at risk for an unnecessary cesarean section, plain and simple. 

          Many obstetricians I work with claim that all the “elective” labor inductions (that is, inductions without medical indication) are because the woman “demands” it.  And don’t get me wrong, there are some women out there who are a bit mislead.  But all to often a woman shows up for a labor induction and it is overwhelmingly obvious that she: 1) wasn’t fully explained both the benefits AND risks of labor induction, 2) wasn’t told that labor induction can take up to three days to complete, 3) wasn’t told that comfort measures like using a jacuzzi tub or shower, walking, using the birthing ball, eating, drinking, and general freedom of movement are MAJORLY restricted during labor induction either because of hospital policy, obstetrician’s philosophy, or the requirement of continuous external fetal monitoring, 4) didn’t realize she had the option to say NO.

 

So there you have it, the Top 8 ways to have an unnecessary cesarean section.  I wish it wasn’t true but unfortunately it IS!

 

In closing I would like to leave you with one of my favorite quotes:

 

“We have a secret in our culture, and it’s not that birth is painful; it’s that women are strong.” ~ Laura Stavoe Harm

         

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26 Responses to “Top 8 Ways to Have an Unnecessary Cesarean Section”

  1. Esther Says:

    So glad to see you enjoyed the post & I like that you attached more info to each point… plus you’re right about #8 too!

  2. nursingbirth Says:

    Thanks for commenting Esther! It’s like a celebrity has checked out my site! 🙂 I really did appreciate your list, I sent it to a lot of my L&D friends and they got a kick out of it!

  3. koganowski Says:

    What’s really sad is that, when asked about the rising cesarean rate, I’ve heard various OBs cite #1 (“just ask”) as one of the primary contributing factors. And while it may be the case that more women are requesting and/or more OBs are consenting to non-medically-indicated cesareans for first time moms, this VERY small percentage of cesareans surely is not the main reason that the cesarean rate is now around 34%! Grr.

    Thanks for posting this list, Melissa! It’s great to see CAM acknowledged in your blog! Yay!

  4. nursingbirth Says:

    Koganowski, thanks for the comment. It is INFURIATING to me to hear OBGYNs at work state exactly what you are talking about. They spread this false notion that the main reason cesarean rates are up is because “that’s what women want!” Oh brother…it just goes to show you how ignorant many OBGYNs are of STATISTICS and RESEARCH!

  5. […] §        Unless absolutely necessary, I would like to avoid a Cesarean.  (One of the best ways to avoid an unnecessary cesarean is to avoid an unnecessary labor induction!!  See #8 in my post: Top 8 Ways to Have an Unnecessary Cesarean Section) […]

  6. Natalie Says:

    LOL, can I add #9: Choose to have your baby at a hospital. This has a lot to do with why I chose a birth center- it enabled me to have an intervention-free birth without having to fight for it!

  7. nursingbirth Says:

    Natalie, Say it Sister! I wish giveing birth in a birth center (and at home) was an option for every woman in America! Bravo to you for making your own choice 🙂

  8. Samantha Says:

    Yup that is what laid to my c/section. Being induced it went down hill from there. I just had my VBAC and did everything different. I let baby come when she was ready and I labored at home till I was ready to go to the hospital. No drugs, got to eat and walk around it was great, painful but great. She was 42 weeks on the dot.

    • nursingbirth Says:

      Samantha, Congrats on your VBAC! You are an inspiration for seeing to it things were different the second time around!

  9. Rosemary Says:

    Wow, what a wonderful blog! It covers so many of the things I have read about and believe in – all in one handy place! I will definitely point my pregnant friends and other natural birth advocates towards it. I agree completely with the reasons you list here – I was determined to have a natural birth and worked very hard to achieve it: I had a midwife, a doula, and prepared myself mentally and physically for the process of childbirth. And it went beautifully! My baby cooperated and I had a wonderful birth experience without or drugs, needles or scalpels. With information, a supportive team, physical and mental preparation, most women can achieve a beautiful and natural birth experience. Keep up the good work!

    • nursingbirth Says:

      Rosemary, THANK YOU for sending this blog to your pregnant friends. Unlike other blogs written by L&D nurses, mine is not geared towards other nurses, its geared towards getting info out there for moms everywhere!! Congrats on your beautiful birth experience!! Thanks for sharing and keep reading!

  10. […] has a great post of the Top 8 ways to have an unnecessary cesarean.     She added one to a different list of Top 7 ways to have an unnecessary […]

  11. Be on the look out for another Obstetric Myths Versus Research Realities by Henci Goer.. I just found out about it and that my home birth midwife Amy Ramano CNM is co-authoring it!

  12. Joy Says:

    Wow I broke a few of those rules but got lucky (had vaginal births)! I think I’ll labor at home longer before heading in and honestly I HATE PITOCIN! I cannot wait to talk to my doctor about his feelings on some of these issues.

    • nursingbirth Says:

      Joy, I am SO HAPPY to hear that you can’t wait to talk to your doctor about his feelings on these issues. I wish there were more moms out there that took your initiative and asked the “tough questions”. Have you ever thought about hiring a doula?

  13. […] blogger.  I first saw the list in “Faint Star Light” with 7 reasons.  Then “Nursing Birth” joined the party, and finally “Enjoy Birth” jumped on the band wagon.  And […]

  14. Jenn Says:

    I continued this post, adding a 10th reason. Please come read my version of the list! http://knittedinthewomb.com/wp/?p=149

  15. Joy Says:

    I can’t afford a doula or I would hire one! My MIL is a “natural” doula (no training) so I’m proud to have her around to help and she’s always concerned with how things are going. I’ll talk to her about this, too, so she can help be my voice in labor when my mind starts to get clouded and my judgement manipulated. She’s NOT afraid to say something (I’m not afraid either but when you’re in labor all you want is to get the baby OUT).

  16. Emily Jones Says:

    Love it! The only thing I would change is #5 – don’t get an amniotomy AT ALL. There is almost never a reason to break a woman’s waters artificially. Studies have shown no significant reduction in the total time of labor, so really, it accomplishes nothing but raising your risk for a ton of other complications, including c-section.

    You might add no late-term u/s, unless indicated by some other concern. Too many inductions and c-sections are based on inaccurate measurements of size and volume. And no induction before 43 weeks, since average gestation is 37-42 weeks. And no NSTs or excessive monitoring prior to 43 weeks either, for the same reason.

    • nursingbirth Says:

      Emily Jones…ALL very good points!! I am currently reading “Silent Knife” by Cohen & Estner and they talk a lot about everything you mentioned. Thanks for your comment!

  17. kgjames Says:

    I agree – don’t agree to AROM. I’m certain that is what lead to my unnecessarian in 2004.
    ~ Kimberly
    http://labortrials.wordpress.com

  18. […] 9)      Seriously consider avoiding interventions in labor that evidenced-based research have shown could increase your risk of a cesarean section, fetal distress, and infection including early amniotomy (breaking of waters), accepting pitocin to stimulate or augment contractions without trying other more natural methods for augmenting labor first, going to the hospital during very early labor, accepting continuous external fetal monitoring as opposed to intermittent auscultation for a normal healthy labor and a normal, reactive, and reassuring fetal heart rate pattern, and requesting an epidural or narcotic pain medication (especially in early labor) before trying all methods of non-pharmacological pain management techniques first.  (Check out my post: Top 8 Ways to Have an Unnecessary Cesarean Section) […]

  19. Really great article! Honest.

  20. abdomendforcsection Says:

    This should be a leaflet handed out to all pregnant women during 3rd trimester. Cesarean delivery is here to stay, but so many are unnecessary. Reducing the medicalization of hospital birth will go a long way to reduce the alarmingly high rates. A big part of that is the education and empowerment of pregnant women – so thanks for all you do!

  21. Thank you for your article. Too many women are uneducated and their doctors want to keep them that way. That’s why I chose a midwife (thank goodness I am not a high-risk patient who needs an OB. I know some people have to deliver with them and have no choice). They are less likely to bully you into all these interventions and procedures.


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