As the c-section rates continue to increase around the world, it seems worth talking about some of the myths people often have about them. The World Health Organization has said that once the c-section rate is over 10% we are actually not preventing more babies and birth parents from dying. We are in fact potentially causing them more harm. This is because surgery in birth puts that birth parent and baby more at risk than a vaginal birth.
In most of Canada, the c-section rate is around 30%. We are increasing the risks to mothers and babies without proven benefits. That’s why I believe that it is important for people to understand what having a c-section represents and to clarify some of the myths.
There are 2 other blog posts related to this one. One on Vaginal Birth After Cesarean (VBAC) and one on tips to increase your chances of a vaginal birth. Surgery during birth is not always avoidable and can save lives, absolutely, no doubt about that. It often can be avoided however, and having the information to be able to give your body and your baby the best chance of birthing vaginally is important.
Myth #1 – One c-section, three c-sections, it’s all the same
The truth of the matter is that the more c-sections you have, the more the risks increase. Scar tissues are formed every time the uterus and surrounding tissues are cut into in order to gain access to the baby. Scar tissues can grow and cover the bladder and bowels. This can cause potential damage to both as well as increased risk of blood loss. Each time you have another c-section, the risks to the next pregnancy are higher. These risks include placenta previa (where the placenta covers the cervix, in part or totally), and placenta accreta (an abnormally attached placenta that can sometimes end in a hysterectomy and is life threatening to the mother).
Myth #2 – ONCE a c-section, ALWAYS a c-section
We used to think that was true. Solid research has shown that most pregnant people who have had a c-section can safely try for a vaginal birth after cesarean (VBAC). If 100 people who had a c-section attempt a vaginal birth with the next pregnancy, 75 of them will be successful. VBAC and repeat c-sections both carry potential risks and benefits. You should have a detailed conversation with your care provider to see how these apply to you.
Myth #3 – Cesareans are less painful than vaginal birth
The majority of people who have had both a vaginal birth and a c-section will tell you that a cesarean causes more pain (in the end) than a vaginal birth in most instances. The pain is just felt at a different point-in-time. They will also tell you that the recovery time after the c-section is significantly longer. If you already have children at home, you may find it extra-challenging. Caring for a newborn along with the older child(ren) while your incision on your belly and uterus is healing can be tough. It is also worth remembering that in general, vaginal births are safer for most than a cesarean birth.
Myth #4 – A c-section is just easier
It is true that the birthing process can be very intense and can be felt as painful. It is also true that at a superficial level, a c-section appears to be so much easier. Once you dig a little deeper, as we are doing here, you can see that in reality there is nothing easy or simple about c-sections. Yes they are commonly done and the surgeons, nurses and anesthetists are incredibly skilled at what they do. But this is major abdominal surgery and that is not easier for you, your body or your baby. It can be necessary in some cases, but not easier.
It is incredibly important to be well-informed and prepared before going into labour. You need to know how to manage the intense sensations that will go through your body. Birthing parents who have received good information on the birthing process, and good one-on-one support (by a knowledgeable birth attendant) throughout their birth will often manage brilliantly. Remember that your body was designed for this. Birthing parents all over the world, since the beginning of modern humans have had no other option but to cope with the sensations of labour and birth their babies. Walk around, eat and drink freely, stay calm, breathe deeply, and have a bath or shower. Make sure you have someone with you who understands the birth process. They will help support you to stay focused and help ease the intensity of the sensations by reassuring you that all is well and that you are doing a fantastic job!
Fear plays a big role in how we perceive and experience pain but that is a blog entry for another day. For now, just know that with proper support and knowledge, you too can go through the birth process and come out on the other side more powerful than ever! There are always medical options available for managing the intensity of the birthing process like laughing gas, narcotics and epidurals if those become necessary. You are never without options but you do have to understand what they are and when they are best used.
Myth #5 – I have no control over what happens to me; it’s up to the health professionals
All of us have choices when it comes to our health care and what happens to us, even when we have a professional to help keep us and our babies safe. Your care provider, either midwives, obstetricians, nurses, nurse-practitioners or family doctors are all trained to listen to your concerns. They are there to provide you with the information that can help you make decisions that are right for you. You can also look up information from the resource section on our website and be reassured that you will find excellent information there that you can trust.
At the end of the day, it is your body, your family, your life, your decision. You will take all the information available to you and inform your care provider of your decision. Your care provider is required, by Canadian Law, to have your consent before performing any procedure or test. Without consent, they will have to honour the plan that you put in place for yourself. You are in charge. The professionals can help you by providing you with relevant research findings, community and hospital standards and even their opinion but they must respect your choice in the end.
Myth #6 – My baby is too big, I need a c-section
In a normal pregnancy, our body tends to grow babies that will fit on the way out. Estimating the size of your baby before the birth is very difficult, even for experienced care providers. Ultrasounds can try to estimate the baby’s weight but they can be off by 20% on either side. Your body and the baby’s body will change and adapt during the birthing process to allow the baby to be born. It is unwise and not recommended to induce labours or perform c-sections because of estimated fetal weight.
It is true that babies in poor positions can sometimes not come out easily or at all through the vagina. Many times however, that can, and will resolve itself if you can move freely and choose positions that will encourage the baby to move into a better position. I offer you some food for thought. Some birth parents who had their first c-section birth because the baby was “too big” are able to birth an even bigger baby vaginally the next time. Here’s to adaptable bodies and adaptable babies!
Myth #7 – If the baby is in the breech position, I have to have a cesarean
We now have powerful research that tells us that carefully selected pregnant people who are followed closely during their birth process can successfully and safely birth their breech babies vaginally. Your care provider will encourage you to consider trying to turn your breech baby to the head down position. It’s a procedure called an external cephalic version or ECV. It is all done externally, on your belly.
If turning your baby is not something you want to do or you try and it does not work, then you likely will be able to try for a vaginal breech birth. Of course at this moment in time, it also depends on your care provider and the hospital where you are planning to birth. If this is not something your hospital or birth professionals offer, then ask them for their help in finding you someone and somewhere in the area where you can birth your breech baby vaginally. It’s very important to remember that a bum-down baby is just another NORMAL variation of birth. There is nothing abnormal about this. It’s just not as common as head-down babies, that’s all.
Myth #8 – If I have a high-risk pregnancy, a c-section is best
Some high risk pregnancies are best delivered by cesarean for the health of the birth parent or the health of the baby. There are, however, many people with complicated pregnancies that are able to safely give birth to their baby vaginally. Every pregnancy is unique. The decision on when and how to birth the baby should be made by you, along with your primary caregiver and with any other care providers that can offer you more specialized help when needed.
Thoughts to leave you with
At the end of the day, you can stack the deck so that you put all the chances on your side to have a vaginal birth and still end up in the operating room. I have to say that in my experiences with families, there is a tremendous difference in how people feel emotionally after a c-section depending on how it all went down. Person “A” who feels they did everything they could to avoid a c-section. Person “B” who feels like they did not know what was happening and what other choices they had that could have changed the course of their birth. It is something that as birth parents we live with for the rest of our lives. We do not forget the birth stories of our children. We may want to in some cases but that is not how it works.
Birth is a process. Let the process unfold as undisturbed as possible so that you minimize the chances of a c-section. It’s a surgery that puts you and your baby more at risk than a vaginal birth.
Josée Nolet is a registered midwife with Generations Midwifery Care. You can learn more about Josée here and here.