I nodded slowly, thoughtfully, and asked, "If it's not too personal to talk about, why did you chose surgery?" Here's what she said.
"During my first pregnancy, my doctor said, with my family history (my mom and my sisters both had to have c-sections with all of their children), that my baby wouldn't descend. I'm just too small, and so are the other women in my family.
Care providers sometimes diagnose moms with a small pelvis, known in medical terms as cephalopelvic disproportion. CP is listed in the A Guide to Effective Care in Pregnancy and Childbirth (Oxford University Press, 2000); Table 5 of this well-respected publication on maternal care states that "diagnosing cephalopelvic disproportion without ensuring adequate uterine contractions" is a form of care "likely to be ineffective or harmful."
Diagnostic tests, such as an ultrasound, are used to calculate the approximate size of the fetus, and care providers compare these approximations to the size of the mother's pelvis (usually also an approximation, since most women don't have x-rays of their pelvises done before becoming pregnant and x-rays are no longer used while mothers are carrying a child due to negative health implications of exposing a developing baby to radiation). Effective Care's authors go on to state in chapter 12, page 83, "...controlled trials show that routine ultrasound measurement of fetal size in late pregnancy results in an increased rate of antenatal hospital admission, and possibly of induction of labor, with no evidence of substantive benefit to the baby."
If a 'small pelvis' is one side of the coin, the other side is 'big baby,' also called macrosomia. By medical definition, a macrosomic fetus is one which weighs more than 4,000 grams, or 8 pounds and 13 ounces. But there's a problem with the macrosomia diagnosis, too - research says, "[Care providers'] ability to predict macrosomia is poor [and] management policy of suspected macrosomic pregnancies raises induction of labor and cesarean delivery rates without improving maternal or fetal outcome."
"My doctor scheduled my c-section on my due date. When she, my doctor I mean - well, when she cut me open, sorry to be so indelicate about it, but I guess that's what happened - she said after the birth that my son was really high inside me. She said, 'There's no way he would have descended - he would never have come down so it's a good thing you chose the operation.' I guess it's a good thing I knew my family history, you know? That way, I was able to tell my OB, and everything worked out for the better."
During the third trimester, baby is carried higher in the body, to the point where mom's diaphragm is unable to pull down as far as it can when she's not pregnant and taking a deep breath can be difficult. One of the things a mom's body does in preparation for labor is allow the baby to descend. Simply put, if a baby hasn't descended at all, then mom's body hasn't initiated this particular part of the process of labor preparation, and baby isn't ready to be born.
In labor, some moms experience arrest of descent, when the baby stop its birthing progress and labor slows or stalls. Usually arrested descent happens because the baby isn't positioned well; and most of the time, helping mom change positions or move around causes the baby to re-situate and continue being born. However, I think it's worth noting that arrest of labor isn't applicable until a mother is actually in labor. If a c-section is performed before labor begins, there's no labor to diagnose as arrested.
I would like to say that the experience of the mom I spoke with was an uncommon one, but in fact, the exact opposite is true. The World Health Organization recommends a c-section rate of between 10%-15%; but the U.S. national c-section rate is around 1 in 3 women.
Jill at The Unnecesarean put it like this:
One of the results of this mass over-diagnosis of labor dystocia is that many women are left feeling inadequate about their bodies, telling friends “I’m just not good at birth” or “My babies just don’t descend on their own” or “My labors just don’t keep going on their own without Pitocin.” While it may be true in some cases and I refrain from passing judgment about individual situations, I remain highly skeptical that labor dystocia is the epidemic that obstetricians are making it out to be by operating so frequently.
I asked mom why she chose a c-section for her second baby, and she said her doctor advised her that a trial of labor after having a c-section for a previous child would result in uterine rupture. The second baby was another scheduled c-section, just like the first. This is fairly routine; many care providers are hesitant, if not outrightly opposed, to a mother attempting to vaginally birth another baby after having one by c-section due to a risk of uterine rupture. It's up to the mother and her care provider to weigh these types of risks, so I like to make sure my clients know that research says "[the] risk of losing the baby because of a scar rupture is in the range of 1-4 per 10,000."
Mom was very intrigued that I'm a birth doula. All of the research I've studied flitted through my heard while we talked, but instead of voicing what I know from books, I shared some of my experiences attending moms who chose vaginal birth. She said, somewhat wistfully, "I'm not unhappy with either of my births, but... I'll always wonder what it feels like, you know...to give birth the usual way." I said maybe she could try for a third, and she smiled, and her husband laughed - both of them had a hopeful gleam in their eyes.
We turned the subject to the joys of raising children, and left childbirth topics behind, but I think our conversation sparked something. Later, as we were leaving the reception and saying our goodbyes, mom gave me a deep and thoughtful look. One never really knows which butterfly wingbeat will incite the monsoon on the other side of the world - maybe I was part of an important moment in their lives. I hope I was able to pass on a sense of empowerment to this mom during our conversation while also respecting her feelings of satisfaction about her birth experiences.
Jill at The Unnecesarean put it like this:
One of the results of this mass over-diagnosis of labor dystocia is that many women are left feeling inadequate about their bodies, telling friends “I’m just not good at birth” or “My babies just don’t descend on their own” or “My labors just don’t keep going on their own without Pitocin.” While it may be true in some cases and I refrain from passing judgment about individual situations, I remain highly skeptical that labor dystocia is the epidemic that obstetricians are making it out to be by operating so frequently.
I asked mom why she chose a c-section for her second baby, and she said her doctor advised her that a trial of labor after having a c-section for a previous child would result in uterine rupture. The second baby was another scheduled c-section, just like the first. This is fairly routine; many care providers are hesitant, if not outrightly opposed, to a mother attempting to vaginally birth another baby after having one by c-section due to a risk of uterine rupture. It's up to the mother and her care provider to weigh these types of risks, so I like to make sure my clients know that research says "[the] risk of losing the baby because of a scar rupture is in the range of 1-4 per 10,000."
Mom was very intrigued that I'm a birth doula. All of the research I've studied flitted through my heard while we talked, but instead of voicing what I know from books, I shared some of my experiences attending moms who chose vaginal birth. She said, somewhat wistfully, "I'm not unhappy with either of my births, but... I'll always wonder what it feels like, you know...to give birth the usual way." I said maybe she could try for a third, and she smiled, and her husband laughed - both of them had a hopeful gleam in their eyes.
We turned the subject to the joys of raising children, and left childbirth topics behind, but I think our conversation sparked something. Later, as we were leaving the reception and saying our goodbyes, mom gave me a deep and thoughtful look. One never really knows which butterfly wingbeat will incite the monsoon on the other side of the world - maybe I was part of an important moment in their lives. I hope I was able to pass on a sense of empowerment to this mom during our conversation while also respecting her feelings of satisfaction about her birth experiences.
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