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Sep242009

"Best of" Week: Enjoy Birth

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Types of Cesareans

There seems to be an epidemic of Emergency Cesareans.  When I talk with moms, or read birth stories, many label their cesareans as emergency’s.  But as I ask questions or as I read details, I see that it wasn’t a true medical emergency, but mom has been led to believe it was.  Even my cesarean, which I have always called an emergency cesarean, really was ‘urgent’, not an ‘emergency’, the difference being the timing. 

Is it just a lack of good definitions for the types of cesareans?  I think in many people’s minds it is either a

 planned cesarean = non-emergency

or

un-planned = emergency.

 

 I have come up with more descriptive labels.  What do you think?  Do you have any to add? 

 

Planned Cesareans: 

 
Elective – mother chooses without a medical reason.  For example: fear of pain.

Care Provider or Mother Convenience – Sometimes care providers will even suggest a cesarean for convenience for him or the mom. 

Medically indicated – mother chooses for a good medical reason.  For example: complete placenta previa.

Care Provider Necessitated/Pressured – Some planned cesareans, may have questionable reasons.  For example:  twins; breech; or suspected big baby

Her OB says it is medically indicated so mom assumes it is, but if she was to do further research, she would find that she has other options.  Many care providers allow twin births, breech births, believe babies grow to the perfect size for the mothers, etc.

 

Unplanned Cesareans: 

Emergency due to natural causes – A life threatening situation to mom or baby.  Time from decision to surgery would be less than 10 minutes.  For example: placental abruption.

Emergency due to interventions – A life threatening situation to mom or baby.  Time from decision to surgery would be less than 10 minutes.  For example:  Breaking of water causes cord to prolapse

Urgent due to natural causes  - Medically indicated, but not currently life threatening. Typically the time from decision to surgery would be 20-60 minutes.  For example:  baby is showing distress due to cord issues.

Urgent due to interventions  - Medically indicated, but not currently life threatening.  Typically the time from decision to surgery would be 20-60 minutes.  For example: pitocin induced contractions causing distress to baby

Maternal Choice due to natural causes  – For example:  mother’s intuition (mother senses something is wrong and upon delivery indeed there is an issue.)

Maternal Choice due to interventions  – For example:  not allowing food causes mom to feel nauseous and exhausted. 

Failure to Progress (or Failure toWait) – progress may be slower than anticipated but mom and baby are doing fine.   OB is ready to go home, or hospital has arbitrary “guidelines”.  For example: mom can only push 2 hours. 

Failed Induction – Your body was not ready to give birth or baby was not ready to be born. 

Often the care provider blames it on mom or baby.  For example, “Oh this baby was just too big or your pelvis was too small. “   This can be damaging to mom, who may think her body doesn’t “work”  Let’s say what it really is, your body and or your baby were not ready.   Or more simply the induction did not work. 

Reluctant Mother Choice / Nothing Else Seems to be Working - This is for moms who have tried waiting hours, different positions.  Mom and baby are still doing fine, but (usually because of baby positioning) no progress is being made and mom is told this is the way baby is coming out.  So mom reluctantly goes forward. 

 

This post originally appeared on the Enjoy Birth blog on December 28, 2008 and was submitted by the author for “Best of” Week.

Sheridan is the mom of 3 boys, a VBAC mom, Hypnobabies Instructor and Hypno-doula.

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Reader Comments (17)

Thanks for reposting this. It really bugs me when I hear women describe their c-sections as emergency and then talk about chatting with the ob, nurses, etc. You don't have an emergency c-section and have a chatty OR like on a baby story. You might have an urgent c-section, but it's not an emergency if people are laughing and talking. There was a visible shift in everything when mine was declared an emergency. My heart (not a typo, the baby was fine, my hr was out of control) rate at been spiking all day and I had staved off a c-section by agreeing to laboring on my side to keep the heart rate under control. At 9:00 it was alarming every time a contraction ended and at 10:57 pm it jumped to 175 and wouldn't come down. They thought that I was stroking out. My son was born at 11:15 pm and would have been born sooner except that there was a tornado and the hospital had to switch to axillary power. The last thing I remember was the ob telling the nurses that they were starting and that the other doc should scrub in as soon as she got there. Ironically, my MIL told everyone that I "decided" to have a c-section. Um, no doc in their right mind does a c-section in the middle of a tornado w/ limited power unless it's an emergency.

September 24, 2009 | Unregistered CommenterG

I am curious as to what category my (primary) c-section would be, according to these criteria. I had planned natural birth in an in-hospital birthing center with a midwife attending. Had reached transition and was doing the "I can't do this anymore!" thing, so the midwife offered to check me (this was in the birth plan--offer to check dilation if I'm flipping out so that I would know that yes, I am getting there). Was found to be 8 cm but midwife was not sure she was feeling a head. Pulled in the portable ultrasound machine and sure enough, baby had flipped breech during labor.

My midwife was not experienced with assisting in a breech delivery. Without a trained attendant, I did not feel safe, and agreed to c-section. I am still (almost two years later) mad at myself for not having thought ahead and finding a midwife who would deliver breech.

Now my only options for a next baby are "trial of labor" at a hospital or homebirth. No birthing center in the area accepts VBAC patients.

Anyway--would this unplanned c-section fall under care provider necessitated? Or urgent due to natural causes? I think maybe you need a care provider necessitated category under the unplanned section as well, as that seems to be where mine would fit.

I guess I am also posting because I want to feel that I did the right thing, that it would be unwise to deliver breech while fighting the hospital and without a trained attendant. I still am mourning the birth I almost had.

September 24, 2009 | Unregistered Commenteranon for this

Anon for This,

I would say that an unexpected breech with an untrained provider would be a reasonable indication for a C-section. Some mothers might feel comfortable with breech birth, but others would not. In one study (or aggregate of studies), the majority of the injuries that vaginally born breech babies suffered were in one or two of the hospitals, which suggests that either the hospital policy or the care providers (i.e., lack of experience) caused problems, since the remaining hospitals' outcomes were not so skewed. So, you get a nervous, untrained care provider during an unexpected vaginal breech birth, and you could end up with a bad result -- I'm envisioning them yanking and pulling on the baby, injuring (perhaps severely) the neck or spinal cord.

Of course, the remedy for the situation, is to train care providers in attending vaginal breech birth. As the situation stands now, there are very few care providers who have *any* experience in breech birth, much less being "experienced."

September 24, 2009 | Unregistered CommenterKathy

Yeah, the "emergency" label kills me. That word indicates to me that the mom was knocked out, no dad/ partner in the OR.

September 24, 2009 | Unregistered CommenterEG

G, that's an excellent point. Everyone in the OR was very chitchatty (although not with me). Makes you wonder...if they could be so leisurely about getting the baby out, why could't they be a little more leisurely in letting ME get him out?

September 24, 2009 | Unregistered CommenterJill

I really wish all women knew there were so many kinds of cesareans. This is a fabulous, informative post.

September 24, 2009 | Unregistered CommenterBuscando la Luz

I call my c-section a "necessary c". Planned homebirth, stalled dialation for several hours combined with back labor, suspected mal-positioned baby, joint decision (me, husband, midwife) to transfer to hospital for epidural. Reached 10 cm, pushed for 3 hrs, baby was still okay. I was okay, but EXHAUSTED after 35 hr labor, back pains were coming back so I consented to the C. Doc found my baby's foot lodged firmly beside her head, her knee bent backward. So, it wasn't an emergency, but necessary to deliver my baby with injury to her or me.

September 24, 2009 | Unregistered CommenterOlivia

Love the list! Although I don't quite agree with placenta abruption being the example given for a true emergency cesarean. I would think more along the lines of uterine rupture where it really is a matter of minutes to get the baby out. With my placenta abruption there was enough time for a consent form to be signed and I was given a spinal and had enough time for that to take affect. I feel like it more closely resembled what you call the Urgent due to natural causes cesarean. I know someone (she's in my ICAN group) who also had a PA and hers was also handled in a non-emergent fashion.

September 24, 2009 | Unregistered CommenterKrista

Krista -- you're right -- some abruptions can be partial, and moms can even have a vaginal birth without harming their babies in these instances (obviously, with close monitoring of the baby to make sure that he's tolerating everything); but with a complete abruption, there is no time to lose.

September 24, 2009 | Unregistered CommenterKathy

Excellent.

Of course my cesarean was labeled "emergency" - but gimme a break. Doctor called for it at 5 pm, then went back to his office to finish seeing patients for 2 hours, then came back at 7, rolled me into the OR, and got the baby out a half hour later. Emergency? Wow... how long would it have taken if it WASN'T an emergency?

Of course in the playgroup for my second pregnancy, allllll the women who had cesareans (and jesus christ, there were a TON) came back from their failed inductions and intervention-laden births claiming "MY cesarean WAS an emergency - it said so right on the paperwork!" Yeah. So did mine. Doesn't make it so.

But these women will only discover the truth when they want to. I think it's far too difficult to recognize that the uterine scarring (and everything that goes along with it) was totally avoidable. We can't let ourselves think that. Everything about our birth has to be important. If a soldier comes home and finds out the war was a mistake, imagine how useless and cheated he'd feel.

September 24, 2009 | Unregistered CommenterTheFeministBreeder
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