Pregnancy & Birth: Interventions (Part 3)
The Cascade of Interventions (Part 3)*
Without going into a discourse on every possible intervention practiced in medicalized childbirth, I’d like to briefly visit a few of the more common practices and list some of the reasons Tom and I decided to avoid them (I realize that emergencies do happen in a minority of cases, making interventions necessary). I discussed midwives here, induction and electronic fetal monitoring in Part 1 of this topic, internal exams and epidurals in Part 2, and today I have information about cesarean sections.
5. Cesarean Sections
So what is the “cascade of interventions,” exactly? Think of it as a domino effect: one unnecessary medical intervention leads to a long chain of interventions, ending in a traumatic birth and an unhealthy mother and newborn, which in turn can lead to even more long-term problems for both.
Maybe that first domino to fall is the induction of labor when the mother and baby aren’t yet ready.
Maybe it is administration of Pitocin to “speed up” labor.
Maybe it is something as simple as making a laboring mother lay still in bed for an hour while a technician fiddles with the electronic fetal monitor.
Each of these interventions has negative side effects that are proven to increase the chance of further interventions, just like dominoes falling. Often, one of the last interventions before a traumatic birth is a cesarean section.
In the past 40 years, our cesarean rate has skyrocketed. In 1965 the rate was less than 5%, today it is over 30% – approximately one in three women will have a cesarean, most of those are unnecessary. (1) This article lists several explanations as to why that rate is rising, a few of which are: (a) low access to supportive care during pregnancy and labor, (b) ignorance of the dangers associated with cesareans, and (c) an increase in other unnecessary medical interventions (aka the cascade of interventions).
“When a cesarean is necessary, it can be a life saving technique for both mother and infant.” It is, however, major abdominal surgery, and thus carries with it significant risks to both mothers and newborns. (2) In a review of research studies, Childbirth Connection compared the difference in risks and outcomes between vaginal birth and cesarean section. Of 37 possible outcomes reviewed, the evidence shows that cesarean sections are found to involve more risk in 33 of those areas. Vaginal birth involved more risk in 4 areas: (a) pain in the vaginal area (that’s kind of a given), (b) incontinence (both urinary and bowel), and (c) risk of nerve injury to babies’ shoulder, arm, or hand.
And the remaining 33 areas that involve more risk with a cesarean? I have most of them listed below.
Risks to Mothers from Cesarean Section
1) Cesarean sections increase the mother’s risk for hemorrhage (severe bleeding);
2) Cesarean sections increase the mother’s risk for blood clots;
3) Cesarean sections increase the mother’s risk for bowel obstruction;
4) Cesarean sections increase the mother’s risk for longer-lasting and more severe pain;
5) Cesarean sections increase the mother’s risk for infection;
6) Because of scarring and adhesion tissue, cesarean sections increase the mother’s risk for ongoing pelvic pain;
7) Because of scarring and adhesion tissue, cesarean sections increase the mother’s risk for twisted bowel;
8 ) Cesarean sections increase the mother’s risk for a longer hospital stay;
9) Cesarean sections increase the mother’s risk for re-hospitalization;
10) Cesarean sections increase the mother’s risk for poorer overall mental health;
11) Cesarean sections increase the mother’s risk for depression;
12) Cesarean sections increase the mother’s risk for psychological trauma;
13) Cesarean sections increase the mother’s risk for rating her birth experience poorer than a mother who had a vaginal birth;
14) Because cesarean sections usually result in a mother having “less early contact with her baby,” she is also “more likely to have initial negative feelings about her baby”;
15) Cesarean sections increase the mother’s risk for future ectopic pregnancies;
16) Cesarean sections increase the mother’s risk for reduced fertility;
17) Cesarean sections increase the mother’s risk for maternal death at birth;
18) Cesarean sections increase the mother’s risk for serious problems with the placenta in future pregnancies (placenta previa, placenta accreta, and placental abruption);
19) Cesarean sections increase the mother’s risk for an emergency hysterectomy;
20) Cesarean sections increase the mother’s risk for stroke;
21) Cesarean sections increase the mother’s risk for a ruptured uterus in future pregnancies;
Risks to Newborns from Birth by Cesarean Section
22) Because cesarean sections pose challenges in forming a breastfeeding relationship, babies born by cesarean section are less likely to breastfeed and to get all of the benefits of breastfeeding;
23) Babies born by cesarean are more likely to be cut (during surgery);
24) Babies born by cesarean are more likely to have breathing difficulties at birth;
25) Babies born by cesarean are more likely to have asthma during childhood;
26) Babies in future pregnancies are more likely to be born too early;
27) Babies in future pregnancies are more likely to have low birth weight;
28) Babies in future pregnancies are more likely to have a physical abnormality or injury to their brain;
29) Babies in future pregnancies are more likely to have a physical abnormality or injury to their spinal cord;
30) Babies in future pregnancies are more likely to die shortly after birth. (3)
Why did I list these out? Because it may be the only exposure some women have to why they should try to avoid a cesarean section – and all unnecessary medical interventions for that matter. You and your new baby deserve to have the best shot at a healthy, happy, relaxed start at life. A natural labor and childbirth in a supportive environment can give you just that.
How to Increase Your Chances of Having a Safe, Natural Birth
If you are interested in a natural birth and avoiding unnecessary medical interventions, there are several steps you can take to increase your odds of having your desired birth experience. Some of the steps advocated by Childbirth Connection are to: a) find a supportive midwife or OB (and one that has low rates of intervention), b) develop a birth plan to share with your provider and support team, c) choose a setting that is conducive to natural birth, d) arrange for continuous labor support from someone who has experience. (4)
When I asked a group of mama friends what they thought the most important factor is to having a natural birth, the overwhelming response was support. Many women want their partner and/or mother in the room with them while they labor, thinking that the presence of a loved one will be enough. I tend to disagree unless the partner or mother in question is also a doula (or someone who has had many objective experiences with labor and childbirth).
Doula, translated from Greek, means “a woman who serves.” Doulas are trained professionals who “provide continuous physical, emotional and informational support to the mother” during pregnancy, labor, and even after birth. Research shows that doula-attended births result in shorter labors with fewer complications and healthier babies that breastfeed more easily. (5) Doulas also provide support to partners, whose help to mothers can increase breastfeeding success and reduce postpartum depression.
If you are concerned about the cost of a doula, take heart – they are affordable. And because doula support will likely help you avoid unnecessary medical interventions, you will make up that cost later in better health and less money spent on health care. If you live in an area that has a doula certification program, you can also inquire about getting free or reduced services by doulas in training.
Another key part of having the birth you want is to educate yourself. Learn what to expect in a natural birth, strategies for managing labor (i.e., hypnobirthing, Bradley method, massage, etc.), and how to avoid interventions. Educate yourself on your legal right to “informed consent” and “informed refusal.” (6)
Experiencing a natural birth is every woman and newborn’s right. Natural birth is also a joyful event that will result in a healthier and happier mother-baby pair. “Most mothers are healthy and have good reason to anticipate uncomplicated childbirth[;]” it is a matter of education, support, and conscious decision-making that make such births possible. (7)
(1) “Why Does the National U.S. Cesarean Section Rate Keep Going Up?,” http://www.childbirthconnection.org/article.asp?ck=10456; see also “What You Need to Know About C-Section,” http://www.childbirthconnection.org/article.asp?ClickedLink=274&ck=10168&area=27
(2) “Cesarean Fact Sheet,” http://www.childbirth.org/section/CSFact.html
(3) “What Every Pregnant Woman Needs to Know About Cesarean,” http://www.childbirthconnection.org/pdfs/cesareanbooklet.pdf; “Best Evidence: C-Section,” http://www.childbirthconnection.org/article.asp?ck=10166
(4) “Tips and Tools: C-Section,” http://www.childbirthconnection.org/article.asp?ck=10170
(5) “What is a doula?,” http://www.dona.org/mothers/index.php
(6) What Every Pregnant Woman Needs to Know About Cesarean
(7) Why Does the National U.S. Cesarean Section Rate Keep Going Up?
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"Pregnancy & Birth: Interventions (Part 3)"
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