By Stephanie Sosnowski

Nationally, the cesarean birth rate has increased from about 21% to 30% since 1990. Some hospitals report cesarean rates of 40%, or more. Is this due to more mothers asking for cesareans because they feel that it will be too hard to push their babies out? Or are they asking for their baby’s birth to be scheduled, just like everything else in their busy lives? The evidence is not yet clear, but the bottom line is that a cesarean birth is major surgery that comes with risks for both mother and baby.

However, a cesarean can be a life-saving procedure for mother and baby when it is medically necessary. Some medical indications for cesarean delivery include:
• Placenta previa (the placenta is presenting before the baby) or placental abruption (the placenta separates prematurely from the uterus).
• Transverse lie – the baby is lying across the mother’s abdomen horizontally.
• Dystocia – abnormal progression of labor (prolonged, uterine inertia, arrest of active labor, prolonged second stage, cephalopelvic disproportion).
• Fetal distress – may be caused by umbilical cord compression.

For families who are planning a cesarean due to medical indications, it can be helpful to speak with the care provider ahead of time to see if surgery can be delayed as long as possible. If the pregnancy is healthy, it is best if baby is born at 40 weeks of gestation. The baby’s brain at 35 weeks weighs only two-thirds of what it will weigh at 40 weeks. During the last six weeks of pregnancy, baby’s brain adds connections needed for balance, coordination, learning and social functioning.

Parents-to-be and their partners may find it helpful to attend a special class on cesarean surgery so that they will know what to expect, and how to best help the new mother during recovery. Remember, that in addition to having to take care of a newborn, mom is now recovering from major surgery and will need some extra assistance.

An unplanned cesarean may be upsetting to the mother, as it is unexpected. However, it is important to understand that the parents made the best decision they could at the time of the birth. All parents want their babies to be born healthy, and will do whatever is necessary to make that happen.

Before going into labor, women should ask their care providers what their cesarean delivery rates are, and what circumstances would elicit their decision to perform surgery. Parents-to-be should also be aware that every hospital is required to provide maternity statistics on their birth practices (i.e. cesareans, episiotomy, vacuum extraction, etc.) upon request. This information can help expectant parents to be more educated consumers about birth. Attending childbirth preparation classes will help parents learn more about the risks and benefits of all procedures, too.

Maternal-Infant Services Network is offering free four-session childbirth preparation classes in Orange, Sullivan and Ulster Counties. Visit www.misn-ny.org or call 1-800-453-4666 to learn more.

Stephanie Sosnowski is the Deputy Director of Maternal-Infant Services Network (MISN) of Orange, Sullivan and Ulster Counties, a not-for-profit organization that coordinates health and human services for pregnant women and children.

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