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Reducing the Complications of Cesareans Is Finally Getting the Attention It Deserves

25 Apr

In 2014 the U.S. national cesarean rate was 32.2%, 1.3 million U.S. women gave birth by cesarean.  According to the World Health Organization, “cesarean section rates up to 10-15% at the population level are associated with decreases in maternal, neonatal and infant mortality. Above this level, increasing the rate of cesarean section is no longer associated with reduced mortality.” Medical, business, insurance and hospital associations are finally beginning to take this issue seriously.

Happy Young Attractive Mixed Race Family with Newborn Baby.

One of the scheduled sessions at this year’s annual American College of Obstetricians and Gynecologists meeting in Chicago will address the “cesarean epidemic.” A popular OB/GYN online newsletter is questioning the necessity of 1 in 3 surgical births and is recommending more patience by physicians before calling a cesarean for failure to progress.

A study of severe obstetric complications in the United States from 1998 to 2005, found an increase in renal failure, maternal respiratory distress syndrome, shock, the need for ventilation, pulmonary embolism, and blood transfusions. The study concluded that the increase in complications paralleled the increase in cesarean sections during those years.

According to the California Maternal Quality Care Collaborative (CMQCC), cesareans in the U.S. have risen by over 50% in the last 15 years without any benefit for mothers or babies. The rates for cerebral palsy and neonatal seizures have not changed since 1980. However, maternal and neonatal complications from the surgery have increased. žOver the last 15 years OB hemorrhage increased by 50% žand blood transfusions during birth increased by 270%. ž The CMQCC found that both complications correlate with the rise in cesarean sections.

The National Institutes of Health has set a goal of reducing first cesareans for low-risk women to 23.9% by the year 2020. California’s health insurance exchange, Covered California, has set a policy of excluding approved provider networks with a cesarean rate higher than 23.9% beginning in 2019. The state wants to reduce the number of medically avoidable cesarean births to reduce complications and costs.

Research shows us that repeat cesareans may do more harm than good for low-risk mothers who can labor for a VBAC. Mothers and babies experience these harms both in the short- and long-term. Cesareans put mothers’ next pregnancy and fetus at risk for complications. Downstream complications include difficulty becoming pregnant again, an embryo that implants in the cesarean scar (ectopic pregnancy), and an increased risk for preterm birth and low birth-weight.

Since almost 90% of women in the U.S. with a prior cesarean will have a repeat operation (most of them as a routine procedure), the CMQCC is set to publish guidelines in April to prevent low-risk first cesareans and support vaginal birth. The CMQCC Toolkit to Support Vaginal Birth and Reduce Primary Cesareans, a collaborative project, includes the contributions of multi-stake-holders such as ACOG, ACNM, AWHONN, AAFP, Blue Shield of California, California Hospital Association, California Department of Public Health, Pacific Business Group on Health, Kaiser Permanent, various university health systems, birth centers and birth professional groups including Lamaze International, Coalition for Improving Maternity Services and Doulas of North America.

Although national consumer advocacy and maternity care quality improvement organizations have brought attention to the risks of cesareans, the addition of the recent release of Safe Prevention of the Primary Cesarean and  increasing interest in lowering  maternal and infant complications of avoidable cesareans may finally move the country towards reducing cesareans in a significant way.


VBAC Education Project, Module 3: A Closer Look at Repeat Cesareans: Benefits & Risks

VBAC Education Project,  Module 5: Four Main Reasons for a First Cesarean: What You Can Do Differently This Time

Coalition for Improving Maternity Services, CIMS Fact Sheet: The Risks of Cesarean Section & Expectant Mother’s Checklist





Support and Encouragement from Nurses Can Help Mothers Achieve Their VBAC

27 Mar

Nurses play a significant role in helping women complete their VBAC labors. Women laboring for a VBAC may have more anxiety than women having first babies, and may need extra support. They are grateful for all the encouragement, validation, and labor progress suggestions that nurses can provide. Many times, mothers have said, “My nurse was wonderful. Just when I wanted to quit and ask for another cesarean, she told me things were going just as they should be. I couldn’t have done it without her.”

Friendly female nurse comforting worried pregnant woman who is having a contraction

The following is a list of suggestions to help nurses support women laboring for a VBAC:

  • During labor, while collaborating with her caregiver avoid formally admitting mothers to the L & D unit until they have a strong active labor pattern.
  • Encourage mothers to continue taking in clear liquids and light carbohydrate snacks in the early phase of labor and liquids in the active phase.
  • Support physiologic birth. Remind mothers to use a variety of positions and ambulate during labor as long as they are comfortable.
  • Suggest that the mother and her partner use a variety of comfort measures, such as heat or cold packs, lunging motions, a birth ball, a rocking chair, or hydrotherapy.

Psychological interventions

  • When meeting the mother for the first time, find out how she wants to labor this time. How does her partner or family feel about a VBAC? What concerns does she have? Why did she have a cesarean? Teach her how she can do things differently this time. Verbal support and encouragement are extremely helpful, especially when nurses help to identify signs of labor progress. Remind parents that 3 out of 4 women who labor for a VBAC have a safe birth. Help her to create the birth environment she prefers (low lighting, quiet, music, no visitors). Smiling nurse talking to pregnant woman lying on bed in the hosp
  • When laboring for a VBAC, some mothers may have anxious moments and flashbacks to their prior birth. Distressing memories of fetal distress or of laboring “for ever” and not getting anywhere. Help mothers to overcome these difficult moments and remind them that this is a different labor for a different baby and that they are strong enough to move through it. Most nurses know when a mother has gone as far as she can and that she needs to adjust to the idea of having a cesarean birth.
  • Give her time to think about what she would like for this birth. Does she want the baby skin-to-skin after birth? Does she want her partner to go with the baby to the nursery if it becomes necessary or stay by her side? Does she want her family to visit her in recovery? Involving mothers in their care and honoring their wishes will go a long way to help them adjust to the loss of the birth they may have planned for and anticipated for months.
  • Many mothers have said that they were left alone after the birth while their partner went with the baby to the nursery (when medically necessary). If a mother does not have a doula and if you can provide one-on-one care for this period of time and talk to the mother about how she is feeling, or how the baby might be doing, she is more likely not to feel abandoned.
  • Mothers, just like their newborns, need to adjust to their new life. Your support, guidance, and compassion will give mothers and babies their best start together.

To find out more about laboring for a VBAC download the VBAC Education Project

The VBAC Education Project






Resolving Emotional Issues About Your Cesarean Birth

12 Mar

Some mothers recover quickly after a cesarean. They resolve and integrate their birth experience as one step towards becoming a mother. Some mothers who have had an unexpected cesarean after a long and painful labor may experience disappointment, loss, sadness, grief, guilt or anger. Often the emotional impact of a cesarean is misunderstood, dismissed, or overlooked. Sometimes mothers have unresolved issues about their cesarean. It is normal to experience a combination of positive and negative emotions.

concept for love, family, and harmony. mother hugging baby tenderly in monochrome

When you are ready, it is important to take the time to process your feelings about your cesarean before you give birth again.

  • Find the right time.
  • Find a safe place.
  • Find someone you trust.
  • Begin to share your cesarean experience.
  • What are the positive things you can think of?
  • Think about what you would like to have done differently.
  • Think about what you need to feel empowered and ready to labor for a VBAC.
  • Talk to your partner about how you feel.
  • Share your experience with other mothers who are likely to understand.
  • Reach out to a cesarean/VBAC support group.
  • Write or draw your feelings in a journal.
  • Hold your baby in your arms and share the positive feelings of your birth experience.
  • Gather as much information as you need to help you understand your cesarean and how to make the changes that you want for your next birth.

For more information about emotional issues after a cesarean download Module 8 of Deciding If VBAC Is Right for You. 




Postpartum Support International

The Traumatic Birth Prevention & Resource Guide

Solace for Mothers

Birth Trauma Association, U.K.

Vancouver Birth Trauma

Trauma and Birth Stress, New Zealand

What Are the Odds of My Having a VBAC?

21 Feb

Although three out of four mothers overall who labor after a prior cesarean are likely to have a VBAC, planning ahead, having a supportive caregiver and patient and encouraging nursing care can make all the difference.

Here are some suggestions that may be helpful to you if you are planning a hospital birth: 1_Page_01

Before Labor Begins

  • Think about your VBAC as any other normal labor and remember that the majority of women who plan a VBAC give birth naturally.
  • If you have never labored before or labored and had your cesarean before active labor, the pattern of your labor will most likely be like laboring for the first time. So you will need more time to complete labor.
  • Make sure that you have discussed all of your concerns with your partner, caregiver, and your doula.
  • Find out if your hospital has an “early labor” lounge where you can be observed but not formally admitted to the labor and delivery unit. This will avoid your chances of having routine procedures and limiting your ability to walk and move around in the early part of labor.
  • Avoid an induction of labor unless it’s medically necessary. […]