Farrah Sheehan Deselle, MSN, RN, CLC, CCE (BFW)
Childbirth and Parenting Preparation, Education and Support Program Coordinator
The Mom’s Place at Catholic Medical Center
“In many communities, about one out of three women give birth by cesarean. Therefore, an essential part of your holistic preparation is learning what to expect, how to decrease your chance of cesarean surgery, and how to cope if you experience cesarean birth.” Pam England, Ancient Map for Modern Birth
April is Cesarean Birth Awareness month. About 33% of women in the United States give birth by Cesarean. This is much higher than in many other developed countries.
As a society there are essential questions we must ask about cesarean birth. Some are discussed in health care settings, among childbearing women, and increasingly in research 1) why are there so many cesarean births? and 2) what can be done to decrease the rates or of cesarean births? These are important questions considering cesarean birth increases the risk for negative outcomes for both mother and baby.
For the mother, she may want to learn about cesarean birth in her community and at her birth place. Preparing for Cesarean birth, even if she is not “planning” cesarean birth is often left out of a woman’s birth classes, books, and conversations with health care professionals. Additional questions for preparation for cesarean birth are 1) how can women and their partners best prepare for cesarean birth? and 2) how can cesarean birth be a birth in which the mother, partner, and baby are active participants and that respects the experience of the human beings involved?
Giving birth by cesarean is a worry of many pregnant women. Different women may want to avoid a cesarean for different reasons, including risks to the mother or baby, increased healing time, postsurgical pain, scars, fear of separation from the baby, fear of the unknown, or not being in control. Cesarean sections have risen dramatically in the United States in the past 20 years. Two years ago the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal Fetal Medicine published an Obstetric Care Consensus on the Safe Prevention of Primary Cesarean Delivery. The intention of the document is to identify areas of practice that can be examined and changed to decrease the incidence of a first cesarean delivery. The focus on preventing a woman’s first cesarean delivery is due to the increased likelihood of further cesareans.
Although there is more understanding and commitment now than in the previous two decades of ways to prevent cesarean, the fact remains, in our culture today, about 1/3 of births are cesarean births. Therefore, when women are preparing for birth, comprehensive preparation includes learning about cesarean birth. Women can take time to be self – reflective in their learning and understand their own beliefs about cesarean birth, and also learn practical information about cesarean birth in the culture in which they will be birthing. Here are some important questions to guide your discovery and awareness:
● What is it about cesarean birth that I am most concerned about? What are my beliefs about it? What are my beliefs about people who have cesarean births?
● How did I come to believe these things? What are the exceptions? If I had a cesarean birth, what might it be like for me? What are some ways I can cope with cesarean birth, what would I need?
● Why and when is cesarean birth indicated?
● What do me, and my support people, need to know about cesarean birth, about cesarean birth in our culture, in the hospital where we are having our baby?
● What are the cesarean birth rates at the hospital or with the provider I have chosen?
● If I am hoping to avoid cesarean birth, what are some things I should know and doprenatally, what about during labor?
● If I do have a cesarean birth, what are some things I can do to be engaged and connected in the process? What and who are my resources?
● What do I need to know about the postpartum experience after a cesarean birth?
● What can I tell myself that is true about me as a mother and person no matter what type of birth I have?
There has been a movement toward natural, gentle, or family-centered cesareans in the past few years. Health care is a rapidly changing industry. Consumers are demanding more choice and payers are demanding investment in value. This is leading health care organizations to recognize the importance and benefits of patient or consumer input in all processes, including the birth experience. However, even when it is known that certain practices are beneficial for the patient, it can take years to put the changes into practice. This is why the consumer voice is so important. When women want change and demand it from their providers and health care systems, it starts to happen. For example, first just one mother has skin-to-skin after a cesarean, then another, after a few months it may become the new normal in a particular setting with more and more women asking and more nurses and providers witnessing the benefits. It takes all participants in the health care process to create a change in practice; the consumer, the providers, nurses at the bedside, nurse leaders, and health care administrators.
In family-centered or gentle cesarean births there may be two support persons instead of one present for the birth. Also, mothers and infants will experience skin-to-skin while in the operating room, and family viewing drapes; clear drapes protecting the surgical area, may be used toward the end of the surgery so that the mother, who is lying flat on the operating table, can see the baby right away. Other ways to make the experience more personalized and gentle are music, massage or reiki before or after the birth, or arriving early before a scheduled cesarean to have time to relax, take a bath, settle in and connect with the baby and the birth experience. Even at the moment of birth, a mother can feel more fully present to the experience by picturing her baby being born, or by giving a gentle “push” as the baby is born.
Changing health care practices to help prevent cesarean births is certainly valuable and effective, but health care professionals and parents-to-be must also remember that even if change is occurring for the better, some women will have cesarean births. Women and infants do benefit from cesarean births time and time again. We must practice prevention as well as comprehensive preparation. Birth is one of the great mysteries of life, no one ever knows exactly how it will go. Preparing for the many ways of birthing honors and recognizes both the mystery of birth, and your power and intention for readiness and self-love in all experiences.
To enhance your cesarean awareness:
For a quick and interesting exercise on how our words impact our thoughts, get some paper and pen. Now, take a moment to say the word C-section out loud to yourself and notice the image that comes to your mind. Quickly, draw it on the paper (don’t think, just draw). Notice what you drew. Pause. Now flip the paper over. Say “Cesarean Birth” out loud and draw the image that comes to your mind when you say this. Notice what you drew. How are the images different? Try this with a friend or two. Do you see any patterns? Most of the time in our culture we see and hear “C-section”, “cesarean”, “section”, or “cesarean section”. The image that comes to mind is an incision, a knife or scalpel, a scar, a belly with an opening, a person lying on a table alone. The word birth is rarely used in association with cesarean, and yet it is a birth. When we say “cesarean birth” many people draw a baby, a baby and a mother, a family. There is a human being involved in the image and a feeling that the mother is participating in the birth. In her book, Birthing From Within, Pam England refers to cesareans as cesarean births. When we use the word birth, we can begin to think about and prepare for cesarean in a very different way.
As of April 2017: At The Mom’s Place our cesarean birth rate is: 22%. Currently, skin-to-skin is practiced following cesarean births in which mother and baby are doing well. In general, two support persons may join the mother in the cesarean birth operating suite. Family viewing drapes are also now available.
At The Mom’s Place, our classes are developed using the Birthing From Within mode ™ (BFW) preparing parents in the body, mind, and heart for the full range of childbirth experiences. Our childbirth educators are nurses who work at The Mom’s Place and in our Special Care Nursery and have received training as BFW mentors. If you want to learn more about our offerings, learn more about preparing for cesarean birth or vaginal birth after cesarean (VBAC) or schedule a welcome visit, call (603) 626-2626 or check out our website www.catholicmedicalcenter.org/moms-place.
Farrah Sheehan Deselle is a Certified Birthing From Within Mentor and coordinator of Childbirth and Parenting Preparation, Education and Support Programs at The Mom’s Place at CMC. She teaches many of the classes and works at The Mom’s Place as a lactation consultant. She has a Master’s of Science in Nursing: Health Systems Leadership. Contact Farrah at: email@example.com.
ICAN – International Cesarean Awareness Network