A pregnant woman holding her belly.
April 27, 2018 | by The Polyclinic

April is Cesarean Awareness Month. The Polyclinic Obstetrics and Gynecology (OB/GYN) providers explain when and why Cesarean sections may be necessary for the health of the baby and mother.

Most every expectant mom pictures her pregnancy ending in a satisfying and safe birth experience for herself and child. And most women want that experience to be a vaginal birth. “Everything we do for the mother and baby is designed to promote a safe, vaginal birth if this is possible for a woman’s specific circumstances,” says Sarah Oman, MD, a physician at The Polyclinic OB/GYN Department. Yet Cesarean sections, commonly called C-sections, are sometimes the best method for the safety of mother and child.

What is a C-section?

The American College of Obstetricians and Gynecologists defines Cesarean Birth—or C-Section—as a surgical procedure in which a fetus is delivered through an incision in the mother's abdomen and uterus. The infant is delivered through the incision, which is then closed with stitches which will later dissolve.

C-Sections Are the Exception, Not the Rule

The Polyclinic OB/GYN providers promote safe, vaginal delivery through the department’s culture of provider-shared coverage. “We have a group that works with each patient family and their goals, no matter the doctor on call,” says Katherine Schwab, MD, an OB/GYN at The Polyclinic. “There’s an effort across the country to reduce first C-sections, also called primary C-sections, when there are ways we could safely facilitate vaginal birth. Preventing a primary C-section also reduces the risk for a woman having a second one.”

C-Section Rates Decreasing Locally

Dr. Oman explains that in Seattle emergency C-section rates for first-time, healthy moms are decreasing. She and Dr. Schwab credit the decreased rates with improved communication and protocols among the medical team. “Across the medical field, there has been standardization of guidelines for delivery,” says Dr. Oman. “Normal labor progresses more slowly than some doctors were originally taught, and we have developed protocols that help the medical team practice patience for different rates of labor progress without accepting additional risk to mom or baby.”

Monitoring Devices Increase Safety During Labor

Additionally, monitoring technology has advanced to provide more accurate reading of electronic fetal heart tracing, which measures the stress of the infant during labor. “This common language for categorizing conditions, used among the medical staff, adds to the safety of the patient,” says Dr. Schwab. “Our providers are patient. We’re happy to wait out a mother’s labor, augment as needed, and give mom and baby every chance for a safe vaginal birth.”

When C-Sections Are Needed

Some patients have pre-existing conditions for which a planned C-section is the safest way to deliver. “There are mothers who’ve had uterine surgery, have a placental abnormality that makes labor unsafe, or have a condition that makes it unsafe for them to push,” says Dr. Oman. Sometimes having twins or multiples necessitates a planned C-section. Other patients, intending to deliver vaginally, may reach a point in labor where a C-section becomes the best method for the safety of mother and child. These situations include:

  • Labor is not progressing, despite patience and augmentation to make contractions stronger.
  • The baby is not tolerating the labor.
  • Labor becomes a health risk for the mother, such as onset of pre-eclampsia (acute high blood pressure), and quick delivery is the safest solution for her recovery.
  • The placenta is covering the cervix, blocking the baby’s exit (placenta previa).

A C-Section Can Be a Satisfying Birth Experience

The need for an emergency C-section can be a departure from the mother’s original birth plan. “We educate patients throughout their pregnancy to prepare them for what to expect at delivery,” says Dr. Schwab. "Patients understand that while a vaginal birth may be their first choice, each delivery is unique, and when needed, we will perform a C-section. Talking with your physician beforehand may not alleviate all your fears, but it will give you a sense of control by knowing what to expect should a C-section be necessary."

Support Throughout Delivery is Key

In the end, the birth method may be a minor factor in the greater experience. According to studies, new mothers report afterwards that what makes their birth experience most satisfying is the constant presence of skilled, emotionally supportive birth attendants (nurse, midwife or doula) throughout the delivery. Other factors contributing to overall satisfaction were the ability to move around during labor and having a physician who was supportive of her choices during delivery.

Reducing the Risk of C-Section

According to Dr. Oman, the following factors contribute to greater probability for vaginal birth:

  • During pregnancy, discuss and plan around pre-existing health conditions with your physician.
  • Avoid excessive weight gain during pregnancy.
  • If the baby is in breech position, consider an external cephalic version (ECV) procedure prior to term in order to turn the fetus to head-down position.
  • Be open to intervention such as induction of labor, labor augmentation, forceps, or vacuum during labor when recommended and explained by your doctor.

“It is common for people to be skeptical about medical intervention, believing it will lead to a less satisfying birth experience,” says Dr. Oman. “But anecdotal stories don’t give accurate credit to the safety benefits that may come from a C-section.” Ultimately, “We play the hand that nature deals us as pregnancy and labor progress, and we see how mom and baby are doing throughout the process,” says Dr. Oman. Fortunately, nature is assisted by the Polyclinic’s team of experienced and patient OB/GYN physicians, who guide each expectant mother and her baby through the safest delivery for both.