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C is for courage Labor & Delivery

C is for courage

When an unplanned C-section becomes a reality.

 What do you mean I need an emergency C-section? No, no, no. That’s not possible. My pregnancy was normal. My mother had four normal pregnancies and deliveries. What’s happening?

I was so excited as I awaited the birth of my new son. I tracked my baby’s development online, had all the latest prenatal magazines and the requisite parenting books, but there was one section I didn’t bother to read: the chapter on C-sections. It just wasn’t something I needed to know. My pregnancy was “normal,” so the delivery would be too, right?

Like many moms-to-be, I hadn’t considered the possibility of a cesarean birth, but even though it wasn’t part of my birth plan, I delivered my baby in the operating room. Looking back, here’s what I wish I knew then …

Wants versus needs
Women in labor unexpectedly face the decision (or the urgent need) for a cesarean every day. Delivery plans can change in an instant if the baby’s heart rate drops, the baby isn’t positioned properly, the placenta separates too early or for a number of other reasons.

Although C-sections are often portrayed as being performed for convenience, much of the hype is wrong. C-sections aren’t always planned in advance. Doctors aren’t anxiously lining up to do them, and most women aren’t eager to have one.

“I was bound and determined the whole way through—I was never having a C-section,” says Renee Chileski, mom of three in Saint Marys, Pennsylvania. In the midst of labor with her first child, Chileski was so shocked when the doctor told her she needed an emergency C-section that she absolutely refused to have it done. Hours later, when the pain became unbearable, she finally agreed. She later learned her son had been breech, and his particular position made a vaginal delivery impossible.

Labor and delivery is an unpredictable process, explains Mark Turrentine, MD, OB/GYN in Houston, Texas, but true emergency situations—when a C-section is required immediately—tend to be very low.

In Chileski’s situation, she had a little time to mull over the idea. In my experience, I didn’t have hours to make a decision. My baby’s heart rate was dropping, and the doctor needed my consent to deliver him immediately. Frozen with fear and shock, I couldn’t think clearly. I had never considered having a C-section. It was the last thing I wanted to do, but it was what I had to do to give my baby the best chance for a healthy delivery. With encouragement from my husband, I agreed to it. In the moment it’s not about what the mother wants; it’s about what the baby needs.

In an attempt to ease the potential shock of a delivery in the OR, Richard Beigi, MD, vice president of medical affairs and chief medical officer of Magee-Womens Hospital of UPMC, notes that he tells his patients soon after they are admitted that a C-section is always a possibility.

Every woman and situation is different, and so is every mom-to-be’s reaction to
the news of an unplanned cesarean. In 1980, there was far less debate over C-sections. When Faye Slade was told at that time she would need one, she asked if there was another option. After the doctor said it was necessary, she said OK. “That’s what they said needed to be done, and I didn’t question it,” says Slade, mom of four in Denver, North Carolina.

In all three cases, there were no prior indications these births would require C-sections. What doctors know, but many women may not, is that because labor and delivery are so unpredictable, all women are at risk for a cesarean delivery, Turrentine says.

Ready for anything
Taking a few moments to explain why a C-section is the best option and acknowledging the mother’s fears may help the situation. Looking back, Chileski considers that she might have been less resistant to the news if she had understood that the baby was breech and there just wasn’t any chance she would be able to have a vaginal delivery. “I wish somebody had told me, ‘Hey, it’s going to be OK. I know you’re scared. It’s major surgery,’” she says.

Doctors know that women who haven’t had any previous warning could have a strong emotional reaction to the news, and they must be prepared to deal with these emotions as well as the delivery, Beigi explains. “We acknowledge that it’s scary and let them know they are not alone. We try to manage and talk them through the process.”

If you find yourself facing the decision of heading to the OR, take heart that doctors don’t take the decision to perform a C-section lightly. It’s not about making it home for dinner or the convenience of being able to plan a birth in advance. Their advice is based on doing what is best for the baby and mother.

“An emergency C-section is only done if there is grave concern for the mother or baby,” Beigi notes. “We would prefer patients deliver vaginally. We all want the same thing. We do our best to optimize the outcome for moms and babies.”

Childbirth is scary. Major surgery is scary. But the decision must be made, and once consent is given the whole world seems to move at warp speed.

After finally saying yes to the C-section, Chileski says she was suddenly surrounded by nurses and anesthesiologists. People were asking her to sign papers. An IV was put in, and a spinal was placed to numb her from the chest down. Within minutes, it seemed, she was being wheeled to the operating room. “I was terrified,” she remembers.

What is likely to be routine for medical workers who are prepared to deal quickly with emergency situations can send moms into a panic, which is why it’s important to be open about your feelings—both in the moment and after the delivery. “We know it’s scary, and we talk with them after the fact about what happened and why it happened because it can be a very nerve-wracking time,” Beigi says.

Despite the quick pace required to prepare for surgery, most moms have the opportunity to be awake for their child’s birth. According to Turrentine, only 6 percent of cesarean deliveries are done under general anesthesia. Because women are typically awake, they have the opportunity to hear their newborn cry and even see the baby right away in most cases.

After the fact
In addition to a slightly longer recovery time, C-section moms could face a bigger obstacle: accepting that labor didn’t go the way they planned and grieving the loss of the experience they had been hoping for during their nine months of pregnancy.

“In the beginning, it felt like I missed out. You talk to other people who had it ‘normal,’ and it’s kind of a letdown,” Slade confesses, “but as time passes you take it with a grain of salt.”

“It still doesn’t seem fair that I didn’t get to [have a vaginal birth]. I think a lot of people think you took the easy way out, and you didn’t really give birth,” Chileski shares.

Many might readily dismiss the emotional trauma of a C-section, but if you are in that boat, know that how you feel is valid. You didn’t have to have a cesarean because you weren’t tough enough or because you did anything wrong. Even if you didn’t have the birth experience you had anticipated, you can take comfort in the fact that at a critical moment you made a decision to do what was best for your baby.

As Slade says, “It can be heartbreaking to miss out on having the same experience as others, but as long as you are healthy and the baby is healthy, that’s all that matters.”  

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