Mothering Outside the Lines

A Team of Doctor Perform a C-section (the doctors are huddled around the woman's abdomen working to extract the baby, the mom's view is blocked by the blue barrier sheet)

The doctor made the call: A. needed an “emergency” C-section.

The anesthesiologist, a handsome, kind man in his late 50s who all the happily married nurses had a crush on, allowed us to be in the operating room. So A.’s husband, her doula, and I were all present for an operation that was done competently and carefully, while A. was awake. Even though they put up a shield between the mother’s head and her belly so she couldn’t see that her abdomen was being cut open, they held up the baby for her to see soon after he was pulled out. The doctors gave him some oxygen, cleaned him up, wrapped him in a blanket and then nestled the baby next to his mom.

It was a beautiful operation and the baby was welcomed by many concerned loving hands.

But even when all goes well, there are many reasons to avoid having a C-section and it’s hard not to second guess this one.

What if the doctor–who had built a relationship of trust and love with her patient during the prenatal care–had come to the hospital and stayed with us for awhile? What if she had told my friend that everything was proceeding normally and that she was doing a good job and the baby would come in his own time before the monitor indicated there may have been a problem? What I mean is, what if the doctor had been present for more than just the radical intervention? And what if the nurses, instead of poking and prodding and monitoring, had given my friend some healthy food to eat, rubbed her back, and helped boost her confidence?

It was the middle of the night. We were all tired. But A.’s labor really was progressing well, the sensations were becoming more intense, and she was getting to that point that most women hit where she was feeling like she couldn’t get on top of the contractions. She was something like five centimeters dilated by then. With a little encouragement (and a lot less distracting and rather ridiculous monitoring), maybe my friend’s baby could have been born vaginally.

Just because cesareans are becoming more common does not mean they are a good thing.

“Cesarean is a life-saving surgery that has major risks and is being used routinely. That’s an oxymoron,” said Medford-based midwife and homebirth advocate Augustine Colebrook when I called her last week. “It’s being drastically overused and abused.”

This major abdominal surgery involves serious risks to the mom and the baby, putting the mother at risk for hemorrhage, infection, and organ damage. The incision is painful and takes time to heal, which means that most moms can’t lift their babies after having a C-section, many experience discomfort breastfeeding because when they try to hold their baby they have to make sure the position is not hurting a still weepy wound. Breastfeeding is also more difficult because the anesthesia used makes mother and baby sluggish and interferes with bonding. And women who have C-sections have a longer recovery time than after a vaginal birth.

My friend Katelyn, whose baby was born eleven years ago, still hasn’t fully recovered from the C-section birth. She had such uncomfortable bloating and gas after her son was born that she was miserable. She could barely get out of bed for days and she couldn’t drive for six weeks. Finding the transition to motherhood difficult, Katelyn was also scared to hold her son because she was sure she would drop the baby. To this day she has bowel difficulties that she feels certain are related to her son’s birth.

If C-sections are difficult for the mother, they’re also difficult for the baby. Studies have shown that babies born by C-section are at a higher risk for allergies, asthma, Type 1 Diabetes, fetal injury, and breathing problems, among other things. The squeezing action of a normal vaginal birth helps get liquid out of a neonate’s lungs. But babies born by C-section don’t get this benefit and are often at risk for respiratory distress. That’s what happened to my friend Nora’s baby. A scheduled C-section, the baby was much smaller than the doctors expected and one of his lungs collapsed. He had to be medically evacuated and he spent the first weeks of his life in the NICU in a hospital far from home. Babies born by C-section can also get bruised or cut from the operation, putting them at increased risk for hemorrhaging.

But there’s another reason to try to avoid a C-section if you possibly can: Last week researchers announced that babies born vaginally have very different bacteria on their bodies than babies born by C-section.

Though we think of bacteria as “bad,” we humans actually need to have lots of “beneficial bacteria” in our bodies. As a baby is born from the womb, he or she gets inoculated with his mother’s vaginal bacteria. This is a good thing and is thought to be protective.

But a baby born abdominally does not get the benefit of this inoculation. Instead of having her mother’s bacteria on her body, she has whatever bacteria she picks up in the hospital.

According to a Colorado University news article:

“Dominguez-Bello [one of the study co-authors] said the bacterial communities of C-section babies were dominated by species from the Staphylococcus genus, most of which are harmless but a few of which can cause severe infections. “These differences we are seeing in this study might be related with increased health risks in C-section babies, although more research is needed,” she said.

Previous studies indicate babies born via C-section can be more susceptible to certain pathogens, allergies and asthma than newborns born vaginally. The PNAS study results may help explain the higher incidence of Methicillin-resistant Staphylococcus aureus, or MRSA, in C-section babies, a hard-to-treat bacterial infection that has been increasing in hospitals and clinics in recent years, according to the researchers.” [my emphasis.]

The study itself is published in the June 21 issue of the Proceedings of the National Academy of Science (PNAS). You can read the abstract on-line here.