Many women begin thinking about and planning the type of birth they would like from very early in pregnancy.
Others plan to just go with the flow and hope for the best.
Either way, when things deviate from an uncomplicated vaginal birth, many women wonder why their birth resulted in a c-section.
Certainly, a healthy baby and mother are of utmost importance during labour and birth.
But they aren’t the only important aspect of birth.
When birth doesn’t go as planned, and when the end result requires a longer recovery that could impact future fertility and subsequent births, it can leave mothers wondering if their c-section was in fact necessary. Some mothers are left feeling emotionally unwell, wondering about the what ifs of their labour experience.
The World Health Organization (WHO) recommends an overall c-section rate of 10-15%. Many developed countries, such as the US and Australia, have c-section rates of around or even over 30%. This suggests that upwards of half of all women receiving a c-section may be having them unnecessarily. How can this be so?
How Do I Know If I Had An Unnecessary C-Section?
So, how do you know if your c-section was unnecessary? Firstly, here are some things you need to know:
C-Sections Do Have A Role In Maternity Care
It would be wonderful if every woman and baby could safely experience an uncomplicated vaginal birth.
While birth is a normal physiological process and often unfolds without complications, sometimes mothers and babies require modern obstetrical care for their wellbeing.
There are several situations or conditions that would necessitate a c-section. Some conditions necessitating a c-section include:
- Malpresentation such as baby lying in a transverse position – meaning baby is sideways and unable to descend into the birth canal. While an external cephalic version (ecv) is a possible option, if baby remains transverse, a c-section is absolutely necessary
- Cord prolapse, when birth isn’t likely to occur within minutes – this is a true obstetrical emergency. If your baby is sitting high and your waters break (or are artificially broken), the cord may come down before the baby, compressing the cord
- Placental abruption when birth isn’t imminent – another true obstetrical emergency
- True fetal distress – heart decelerations at certain points in a contraction pattern are within the realm of normal, as long as baby recovers quickly. However, with true fetal distress, baby’s heartrate doesn’t recover between the contractions. Unless birth is imminent and an assisted vaginal birth is possible, a c-section is necessary for baby’s safety. Something to consider though is an unnecessary induction (one with no evidence that mother or baby are actually in distress) can cause stress to a baby, which then requires a necessary c-section. So an unnecessary procedure can create necessary ones.
- A uterine rupture which can occur during a regular vaginal birth, induction or a VBAC (vaginal birth after a c-section)
- Pre-eclampsia and/or high blood pressure that isn’t tolerating spontaneous labour or an induction/augmentation of labour.
- Signs mother and/or baby are not tolerating labour well, unstable vital signs despite medicinal attempts to resolve, or positional changes
- Signs of serious infection, such as chorioamnionitis which can impact mother or baby safety
There Are Some “Gray Area” Conditions Which Might Require A C-Section
While there are situations in which we know a c-section is necessary, there are other situations which might necessitate a c-section in some mother baby pairs, but not others. In these situations, it can be difficult to know for sure whether your c-section was necessary or unnecessary.
While you may not be able to pinpoint for sure, knowing these situations might help you process your experience. If you know that your condition meant a c-section could be necessary, you may be able to assume your care provider was acting in your best interest to avoid further complications. Knowing might also help you to make an informed decision about future births, and help you to explore preventative measures and options.
Some situations which might necessitate a c-section include:
- Breech Position – when baby is coming feet or bottom first, many providers recommend or only offer a c-section birth. Vaginal breech delivery is a possibility, but it depends on the type of breech, your care providers’ skills and birth facility policy (some women will travel quite far to find a facility offering vaginal breech birth). An external cephalic version and other treatments might also be an option prior to labor to prevent a c-section. Here are some interesting facts about breech babies.
- Fetal Distress – In some situations, fetal distress is due to a medication (e.g. an induction and/or pain relief), positioning, or it could be part of a normal birth (heart decellerations during contractions are typical). True fetal distress occurs when position changes, reducing medications and fetal stimulation do not improve the baby’s heartrate. Therefore a c-section is necessary. If fetal distress is quick and severe, then there isn’t time to try different things prior to a c-section. However, if fetal distress is suspected but isn’t certain, some providers may try maternal position changes, stimulating baby via touch (if they’re in the birth canal), or reducing any induction or augmentation medications.
- Twin or Multiple Pregnancy – In some cases, twin or multiple births can be very high risk. When babies share a placenta and a sac, a c-section is often recommended. However, in situations where babies have their own sac and/or placenta, and baby A is head down, a vaginal birth is an option. Even in the case of a breech baby A, some providers will offer a vaginal birth. A vaginal birth is even possible for some triplet births.
- Failure to Progress (FTP) – This seems to be a ‘catch all’ term for when labour takes longer than the expected timeframe — a timeframe that can vary greatly from one care provider to another. If mother and baby are tolerating labour well, both with healthy vital signs, often failure to progress might be nothing more than failure to wait. Giving a mother some more time to rest, change positions, and perhaps get a meal, might be all that is necessary to get things moving. If failure to progress occurs following a necessary induction (e.g. pre-eclampsia) or there’s been a prolonged rupture of membranes which includes signs of infection, then FTP might indicate a need for a c-section. Here are 8 natural and effective tips for a stalled labour.
- Cephalopelvic Disproportion (CPD) – This is when baby doesn’t fit through a mother’s pelvis. While this is a common diagnosis for needing a c-section, the reality is that CPD is quite rare. In many situations, poor maternal and/or fetal positioning and impatience are the true cause of needing a c-section. CPD does occur, but it isn’t as common as many believe. You can read more here.
- Previous C-Section – This can sometimes lead to a repeat c-section. However, current evidence supports a VBAC as a very safe option for many women, even after multiple c-sections.
It can be difficult when your c-section falls into the gray area, because you may not know whether it was truly necessary or not. If your c-section does fall into this gray area, know that you made the best decision you could with the information you had at the time. When it comes to future births, you can discuss the diagnosis that which led to a c-section and your options for your future births. You can also request to have a copy of your medical records, if you wish to see what notes were written about your birth. If you feel the need, there are ‘birth de-briefers’ available who can help you talk through your experience. They are usually connected with doulas and independent midwives, so if you want to locate one, start there.
The Cascade Of Interventions Can Lead To C-Section
Sometimes a c-section becomes necessary because the mother or baby isn’t tolerating labour well or labour isn’t progressing. However, these situations may have occurred due to external factors, and not mother or baby’s health. When we look at normal physiological birth, there’s a complex hormonal process which often unfolds without complications. When we interfere with this process, we run the risk of creating complications.
During normal physiological labour, we have very high levels of the hormone called oxytocin. Our bodies release this hormone in a pattern, like waves, which allows mother and baby a chance to rest between contractions. When left to choose, most women remain upright and active during labour, which facilitates fetal movement and positioning into the birth canal. When in a comfortable environment with support, mothers release endorphins, nature’s pain relief, which helps her to cope with contractions.
When we interfere with this process, oxytocin release might slow down, and thus labour slows. When we remain in bed and inactive, we aren’t assisting baby to move down into the birth canal, nor are we facilitating optimal fetal positioning. This can increase the risk of malpresentation, as well as a CPD diagnosis.
If we opt for an induction or augmentation of labour when it isn’t medically necessary (perhaps for convenience, a specific birth date or provider being on call or to speed up the labour process) we unnecessarily increase the risk of a c-section becoming necessary. Both augmentation and induction increase the risk of true fetal distress. An induction doesn’t always work and often a failed induction can lead to a c-section.
What Can I Do If I Think I Had An Unnecessary C-Section?
Unfortunately, we cannot go back and change things, and as we know, hindsight can often seem to be 20/20. If you’ve had a c-section you believe was unnecessary, while you can’t change the past, you can use information to prepare you for future pregnancies and births. You have the power to research, get informed and be in control of the decision making process.
It’s important to remember that you made the best choice you could, given the support and information you had at the time. Moving forward, you might find support networks (such as ICAN) helpful in processing your experience and planning for your future. You might also explore your maternity care options and find another maternity care provider could offer you a different experience and help you with a VBAC should you desire one.
Remember that it’s okay to grieve the birth experience you didn’t have, and that it doesn’t reflect your appreciation and love for your baby. It’s okay to question and/or be frustrated about the care you had during birth. It’s also fine to be perfectly okay with your c-section experience and have no regrets about how your birth unfolded.
Recommended Reading: Birth Reclaiming Ceremonies, Helping New Mothers Heal.