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An Inconvenient Birth

I love this:

“Honestly? It wasn’t the worst experience of my life (except for the hospital food) and the end result was a healthy baby, which is more important than how he got here. In my case, it was necessary.  But my own opinion (and some will, no doubt, disagree with me) is that no one should have a cesarean unless there is an underlying medical condition or a complication that warrants one. They aren’t easy. They aren’t hard, either. But they aren’t fun. And c-sections are not convenient.”

Over at The Stir, blogger Marj Hatzell has written a really funny and candid account of her c-section. It wasn’t what she planned– she’d even been through non-medicated vaginal birth once before and she was ready to rise to that challenge again– but it was most definitely necessary. There were positional problems, placenta problems and more.

But Hatzell asks why on Earth would you go through this if it weren’t the life-saving surgery it was for her? She laments that women are often led to believe that c-sections are convenient. But convenient for whom? C-sections are major abdominal surgery. It’s no walk in the park. Some say that whatever pain you miss from labor, you get on the flip side with recovery. Plus there are additional risks of infection for mom and baby.

The majority of women who get c-sections don’t ask for them outright. C-sections upon maternal request (commonly, but incorrectly, called “elective c-sections”) actually make up a very small percent of total c-sections. But these numbers can be a little bit deceiving. Maternal health professionals I’ve spoken with say that women who secretly or outright want a c-section are often lucky enough (in our c-section-friendly medical culture) to have or find a doctor willing to come up with a convenient “medical reason” to perform one.

A few of the common ones are: fetal distress, failure to progress and big baby syndrome. There are no benchmarks for what constitutes “fetal distress” and “failure to progress,” so while these are most definitely legitimate reasons for a c-section in many births, they are also terms that can sometimes be used loosely. Or at least they represent a subjective interpretation of events. (An interpretation, some would argue, that is often just as informed by malpractice laws as evidence-based medicine.)

Another sometimes suspicious reason for a c-section: the baby is too big. Sure, a very big baby can sometimes present problems that lead to a c-section. But research has clearly shown that estimations of fetal weight can be off by two pounds in either direction! Often a baby will be delivered via c-section due to its “huge” size, only to be come out into the light at a whopping 7.8 ounces or some such reasonable weight.

And even if the baby is 9+ pounds, large babies can be born vaginally, even to small or “slim-hipped” women. It’s mostly not about mom’s size, but the way the baby and mother’s body work together, and this dynamic is usually not something you can determine before labor has started. There are also ways to help the baby move down and the pelvis open by getting into squatting and/or gravity-friendly positions.

There is a real condition of very large babies called impending fetal macrosomia, but it’s not that common and there are usually other things going on like serious maternal obesity. In these cases, it does make sense to consider the option of surgery.

The point is, there are very good reasons to take on the hard work and increased risks of a c-section. And there are some not-so-good reasons.  Here are some ways to avoid an unnecessary c-section. And here’s a great guide to everything you need to know about c-sections.

photo: Tammra McCauley/flickr

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