Pregnancy Signs & Symptoms, Week by Week Pregnancy Guide

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• Why haven't you touched more on the safety issues? What about statistics? Whoever wrote this can't honestly believe this will make women think it's a-ok to have a cesarean do they? Do they think women are so ignorant we are going to believe someones ramblings without proof to back it up? What about how the maternal mortality rate and it's increase that correlates to the cesarean rate increase? What about the number of mothers that die either from the surgery or complications. What about issues of infection, the last thing a new mom should have to do is pack an infected incision every day (shudder) What about the very real risk of cutting the baby? Yes, it does happen!
  No labor pain, what about pain after delivery? The recovery from a cesarean is twice as difficult than a vaginal birth. Labor is only for a number of hours and yet recovery from a cesarean lasts for days/weeks/months. How about caring for a newborn (and possibly more children)after a major abdominal surgery?
  Dignity and privacy, there is no dignity lying in bed with a chux pad under you catching the blood post delivery. There is no dignity in moving post cesarean when you can't fully stand up or move on your own. There is no privacy having your stomach sliced into, intestines moved and uterus lifted out.
  Trauma for the child- that 'trauma' also helps to squeeze the amniotic fluid out of the babies lungs. That trauma also helps with maternal-baby bonding by a release of hormones that can't be replicated through synthetic hormones and ripping the placenta out.
  Finally, scheduling the delivery. We all have such hectic lives and scheduling a delivery has a nice ring to it BUT we must ask what harm comes of it. We must ask if the outcome is worth the risk. In most cases, it simply is not.

• Eliza - The statistics and safety issues about C sections are well known and very well publicized. C sections are major abdominal surgery and have all the various risks that are associated with them. That is not in dispute here; it is not suggested otherwise. Infections are not unheard of in vaginal births either.

  Yes recovery time is also more prolonged with a C section, however many women do prefer to under the finite pain of post operative recovery than labor pain. Some women also find recovery from a vaginal birth difficult. Also for every woman that underwent a C section and said it took time for them to recover, there is a woman who will say that she was changing diapers within two days of the C section, as was the case with the writer of this article and who wanted to share her experiences with other women, so that they could themselves evaluate the risk and decide if it is indeed worth it.

• I have had two cesareans and there is NO benefit to them. They are painful, scary, and have a 3 times higher risk of neonatal death. Anyone who is OPTING for an elective cesarean should know the SERIOUS life threatening risks, and not allow their provider to sugar coat the real risks because it is easier for the doctor.

• Danielle – Yes these dangers are well documented but like we said, the writer has had very positive experiences with both her C sections and wanted to share this fact. She found the pain to be manageable (she refused and was able to manage without pain medication after surgery because she was afraid it would impede breastfeeding)

• I hope people who stumble across this know enough to look for info that is well-researched and cited with proper sources. Try ICAN (International Cesarean Awareness Network) or Childbirth Connection for some evidence-based info.

• Meanest Mommy Again, the pitfalls of a C section are well documented, we wanted to highlight that there are some positives. BTW we enjoyed your blog.

• The World Health Organization firmly states that the safest cesarean rate for both mother and baby is 10%-15%. The United State's cesarean rate is currently at 31.8%! More than double than the safest recommended rate, and it's rising every year! The United States ranks 29th in the world in infant mortality. Fewer babies die in countries with lower cesarean rates. Our maternal mortality rate is also on the rise. Those statistics don't appear to be very "safe" to me.

  Cesarean sections are by far more painful than vaginal deliveries. This article does not mention that after undergoing a c-section, you will not be able to care for your baby by yourself, climb stairs, or drive for two weeks after the baby is born. After I had a cesarean, it was incredibly painful to laugh, sneeze, or cough for weeks. You have a serious risk of rehospitalization due to infection. Breastfeeding is much more difficult after a cesarean, as well.

  Cesareans come with more privacy and dignity? There is nothing private about a nurse shaving your pubic area with other doctors and nurses "milling about" to prepare you for surgery. Or needing a nurse to help you undress, remove the dressing over your incision and shower after the baby is born. How much dignity is there in the hours upon hours of vomiting into a plastic bucket held by a nurse or your husband/partner after the surgery? Or desperately seeking the advice of a pharmacist days after returning home because you haven't had a bowl movement in almost a week?

  No trauma to the child? That "trauma" is meant to clear the baby's lungs of amniotic fluid. Babies delivered via cesarean have a higher risk of needing deep suctioning and a visit to the NICU for breathing assistance. Baby's heads are meant to mold to fit through the birth canal. The head will take on a "normal" shape within days of delivery.

• Ambosh – Yes the statistics are well known and easily available on the internet. For all those women who compare vaginal deliveries unfavorably with C sections, there are usually an equal number who do the reverse. If you look here http://answers.yahoo.com/question/index?qid=1006020906747 for instance, you will see that women have had quite a few positive experiences with C sections, though there is no dispute that natural deliveries are the preferable way to go; women’s bodies being designed for it and women having done this literally since the dawn of time.

  However in that discussion there is also a woman who regrets the fact that the decision to perform a c section was not taken earlier by her doctor; that it was left till almost too late.

  Also look here http://www.medhelp.org/posts/Maternal--Child/natural-delivery-vs-c--section-open-forum/show/334319 for women who have had positive and negative experiences with a C section. Point being that there are positive and negative experiences with both kinds of birth.

  Requiring suction for a C section baby is an extremely rare occurrence, and it is not unknown even in vaginal deliveries as a Gynae and OB that this site spoke to personally told us.

• Just because a cesarean is "safer than ever before" does not mean that it is SAFE. Cesareans are riskier to moms & babies than a vaginal birth is.

  The way to avoid the dehumanizing treatment in hospital vaginal births is not to have a scheduled cesarean- it's to choose care providers who practice safe, evidence-based, respectful care.

  But hey, if you want to place yourself, your baby, & your future baby under avoidable risks & deal with weeks, months, or even YEARS of post-op pain unnecessarily because you don't want to deal with a few hours of labor, then go for it. . .

  My first was born by planned cesarean. My second was an unplanned (& unnecessary) cesarean that resulted in avoidable emotional & physical trauma. Even though one was necessary & planned, they were BOTH dehumanizing & traumatizing. My third was born after 2 1/2 DAYS of NATURAL labor at HOME, almost 10 lbs with both hands by his head, & I didn't even tear or "need" an episiotomy, & it was millions of times better than either of my cesareans. More importantly than my experience was the love, care, & safety that my third child was born in to.

• LNC Again we are not disputing that C sections are risky, just that women should be able to make a decision based on facts from both sides. When you say, “2 1/2 DAYS of NATURAL labor” that is precisely what women want to avoid, and they should have the choice to do so without guilt.

• Wow-I don't know where to begin. First of all, no trauma to the baby? My son had a vacuum extraction during our csection. My daughter was cut by the scapel during her csection. So there is no trauma? They also got pulled out-I have some pictures that would challenge your assumption that the surgery is easy on the baby.
  As for length of enduring pain, I guess that also depends on personal tolerance and pain management protocols at the hospital. I have had friends who ran out of their prescriptions and had to beg for more pain relief. I have also known several women whose incisions became infected and had to have their wounds packed for weeks. They had no idea how long their ordeal was going to last. I also do not feel that being shaved by nurses protected my privacy at all (never mind the itching near the incision post-surgery!)And then you have to have the nurses check your discharge and change your pads for you post-partum as well. And multiple csections are not safe if you plan on having more than two children-the risks of having placental issues goes up exponentially with each surgery.

• I'm not going to comment on the article itself--only to let you know that I know of multiple people who are writing comments that are not being "approved" as of 5:20 pm EDT. Unless you want thepregnancyzone.com to go down in history as a biased, poorly researched, one-sided website, I suggest you publish the comments that are being sent to you. Sooner rather than later.

• Lily – Hope your concerns have been addressed.

• I'm really appalled that you are lauding elective cesarian sections as a safe and comfortable alternative to natural childbirth. As an emergency procedure c-sections are a wonderful, valuable tool, but in no way are they superior to uncomplicated natural childbirth! I resent that you are essentially encouraging women with no prior experience giving birth to CHOOSE an operation with all it's inherent risks, in favour of letting their bodies do what they are designed for. I think you are exploiting a very common fear and misconception that labour and delivery are grim, painful and debilitating experiences. I have had both a c-section with my first child and a natural birth with my second and I can tell you that the pain of the second labour and delivery was nothing compared to the pain of recovery from the c-section. My emergency c-section was completely necessary, and I applaud my doctors for the excellent job they did, but I would never trade my experience of a natural, uncomplicated delivery for a c-section. It also took me weeks to recover fully from the operation, while I was up and at it the DAY AFTER my vaginal delivery. How on earth is that less painful? As for dignity and privacy, how is a c-section either diginfied or private?? I had about 5-8 doctors and nurses staring at me down there while I was strapped down to a table. Terribly dignified. As for the argument of convenience... since when have babies EVER been convenient creatures? Perhaps it's best we learned that sooner rather than later.

• Kate Hansen – May we clarify that we are not “lauding elective cesarian sections as a safe and comfortable alternative to natural childbirth” or as being “superior to uncomplicated natural childbirth”. Being aware of all the risks, if a woman wants to make a decision surely that decision should be hers to make without guilt?

• Cesarean Section - What Happens During Surgery

  If the mother is to be conscious, an anesthesiologist will inject spinal or epidural anesthesia (usually fentanyl, a derivative from the opium family; and bupivicane, a derivative from the cocaine family) into the mother’s back or epidural space (between the vertebra) via a thin catheter. Vomiting and/or dry heaves may occur as a reaction from the narcotics, as may uncontrollable shivering. A catheter is inserted into her urethra to allow urine to be eliminated.

  In a sterile operating room, with a surgical team in "scrubs", masks, hair net, and gloves, preparation continues with strapping the mother’s arms, crucifix-style, to an operating table. A nurse starts an IV with fluid and/or narcotics (usually demerol or stadol, a derivative of the morphine family), and an anesthesiologist applies oxygen and/or general anesthesia. A curtain is hung between the mother and her lower body to prevent her from seeing the surgery. Her belly is laid bare and she is completely naked, save for a hospital gown that is now pulled up to her neck or just below her breasts. Her belly and pubic area are rubbed with a 10% Povidone-Iodine solution (a.k.a. "Betadine") and her pubic hair is shaved. A sticky plastic drape is laid over her belly to stabilize her skin.

  A horizontal incision is made with a scalpel, just above the pubic bone where the pubic hair begins, slicing through five layers of skin, tissue, and muscle: 1) the derma, or outer layer of skin and 2) fat; 3) the fascia, the tough, thin layer that supports the muscle; 4) the rectus muscle, which is manually separated with the fingers down to the pubic bone; and 5) the peritoneum, the shiny layer that encases the entire abdominal cavity. Suction is applied to absorb excess blood. A metal "spatula" known as a bladder blade is inserted to pull back and protect the bladder. Another "spatula" known as a retractor is inserted at the top of the incision and/or on the sides, and are pulled back tightly to enlarge the incision, usually by two surgical assistants. Another incision is made into a sixth layer, the uterine lining, taking care not to cut the bladder, causing infection. Suction is again applied. Sponges and gauze are used to blot blood and fluid pooling in the abdominal cavity.

  The mother may feel intense pulling and tugging to dislodge the baby’s head from the pelvis. If vertex, the baby is pulled by the neck backwards out of the pelvis and then by the head through the incision in the uterus. The baby’s nose and mouth are then suctioned to remove any amniotic fluid, mucous and/or meconium from the airway. The remainder of the baby’s body is pulled from the mother’s uterus through the abdominal incision, taking care not to tear the uterine or abdominal incision wider.

  The umbilicus is clamped and cut immediately and the child may be held up over the curtain for the mother to see before being taken to a warm table to be suctioned further, toweled off, footprinted, weighed, measured, tagged and wrapped in a blanket and hat. Pitocin and/or methergine is immediately injected into the mother’s IV to begin contractions of the uterus to aid in the removal of the placenta. The remaining umbilicus is then pulled and the placenta is scraped off the uterine wall by hand to tear away the placenta from the uterine wall. The placenta is removed and examined to ensure all pieces are intact. The uterus is then removed from the mother’s body and placed on her stomach for the incision repair. One set of stitches is made in the wall of the uterus, then a second layer of stitches in the outer lining. The uterus is then pushed back through the abdominal incision and into the mother’s body. Sponges and gauze are counted to ensure none are left in the surgical cavity. The abdominal cavity is irrigated with water to flush out bacteria (to prevent infection) and check for bleeding.

  Approximately 1000cc of blood is lost during the procedure. A layer of absorbable stitches are made in the rectus muscle, another layer of sutures are made in the fascia. The plastic drape is pulled away from around the abdominal incision and another set of absorbable sutures or staples may be used for the outer layer, usually removed three to five days later by a nurse. A second dose of demerol may be injected into the mother’s IV to aid in relaxation as she is wheeled into recovery to hold her child when the physician allows it. Again, the mother may experience dry heaves and/or uncontrollable shivering and chills.

  Within 24 hours, the urine catheter is removed and she is allowed to stand and perhaps walk to the bathroom or shower. Within three to five days she is discharged and permitted to return home, with a check of her incision in two weeks. If infection or seeping occurs, antibiotics may be prescribed. Incision pain may occur constantly or intermittently for up to a year or more. Feeling may be regained on the incision site, or nerve damage may result in permanent lack of sensation. Her ability to birth normally in the future may be called into question.

• Cindy Hudson – Thanks for your detailed comment

• Risk of Cesareans
  In the first cesarean
  1 out of 154 women will have a hysterectomy, 1 in 25 will have a blood transfusion and 1 in 417 will have placenta accreta.

  According to the CDC in June 2009, a women who has an elective cesarean has three times greater risk of DEATH than if she had a vaginal delivery.

  As a result of the first cesarean, it may not be possible to have a vagainal birth after cesarean due to the multiple state bans on VBAC. Major complications can occur with placental placement and miscarriages and stillbirth may occur during the second pregnancy. If she is able to get pregnant and carry to term and a second cesarean is performed:
  In the second cesarean:
  1 in 238 women will have a hysterectomy, 1 in 65 women will have a blood transfusion, 1 in 323 women will have placenta accreta, 1 in 23 women will have major complications, 1 in 5 women will have dense abdominal adhesions (uterus and abdominal wall grows into intestines and affects fertility even further)

  The Maternal Death Rates have continued to rise due to increase in elective and non-medical Cesarean Sections.

  Promoting cesarean as a beneficial way to give birth is only going to increase the cesarean rate which in return increases many risks to the mother and the baby.