CESARIAN SECTIONS........

WHO IS BIRTH INDIA?
Birth India’s mission is to promote the benefits both physical and psychological of natural childbirth and the best practices to achieve normal birth. We recognize the evidence that mothers and babies fare better in natural birth. We emphasize that birth choices are a women’s rights issue.
THE PURPOSE AND BENEFIT OF THIS BROCHURE:
ABOUT CAESAREAN SECTION:
Also known as C-section, it is a surgical procedure in which an incision is made in the mother’s abdomen and uterus to deliver one or more babies. It is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk.
Caesarean section is on the rise worldwide, urban India has very high rates, preliminary studies estimate the rate of caesarean surgery in India to be 50% and even as high as 85% in some private hospitals (as informed by the consumer health organization – Mumbai). The World Health Organization states it should be no higher than 10-15%.
Birth India believes this rise is due to many factors including income generation, casual attitude towards surgery, providers’ fear of lawsuits, lack of informed decision, failure to support normal physiologic process, time restrictions and the misconception that C-section is actually healthier and safer for both mother and baby. The rise is NOT based on best evidence based care.
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There are many myths and much controversy surrounding this surgery, we hope this information will help you be better prepared to make informed decisions for you and your baby.
WHY IS ALL THIS IMPORTANT?
The way we give birth can affect us and our families and the whole society. Current research shows how we birth can effect whether or not we breastfeed, how quickly we recover, whether we have emotional difficulties after birth (e.g. difficulty bonding as a family) and even how we will get pregnant again. Healthy birthing establishes the health of our family.
There are many organizations that compile the most up-to-date studies and research comparing the risk of vaginal birth verses caesarean birth. The evidence is clear: unless there is a compelling and well-supported reason for caesarean section, vaginal birth is the safest way for women to give birth and babies to be born. When the surgery is used for convenience, financial gain or fear and performed without sound medical justification, it puts mothers and babies at risk.
Of course when delivering a baby by caesarean section, when medically necessary, it can be a life saving surgery for both mother and baby, and therefore worth the risks involved. Birth India recognizes this and educates to allow informed decision making.
It is time to get informed!
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RISKS OF CESAREAN SECTIONS
Disclaimer: All pregnancies are unique and must be individually assessed with your care provider. This is an information brochure and the following is not intended as medical advice, we are providing consumer education.
RISKS TO MOTHER:
 Haemorrhage, infection, adverse reaction to anaesthesia, post operative blood clots. Post operative endometriosis, emergency hysterectomy, organ damage, bowel problems, lingering abdominal pain and painful intercourse. Thrombosis, uterine and wound infections.
 Increased risk of post natal depression and post operative stress disorder. Difficulties in the attachment and bonding process with the baby, (which can lead to a sense of dissociation and disconnection with the baby), problems in latching and breast feeding. Feelings of inadequacy, guilt and failure in not completing a natural process or even being an informed part of the process.
 The necessary epidural can cause lingering numbness in legs and feet, head ache and back ache.
For more information on risks ….this is not an inclusive list, get informed!
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RISKS IN SUBSEQUENT PREGNANCIES:
 Serious problems with the placenta such as growing deep into the caesarean scar tissue (placenta accreta) or separating too early from the uterus (placental abruption);
 Ectopic pregnancies, stillbirth, and low birth weight;
 Higher rates of infertility and miscarriage;
 Higher chances of repeat caesarean sections.
RISKS TO BABIES:
 At Birth: Possibility of Surgical injuries, difficulty maintaining body temperature, breathing problems, and disorientation
and shock.
 In the post partum: Difficulty in getting breastfeeding established and also jaundice.
 In the long term: Increased incidence of allergies and asthma in childhood and adult life, possible neurological disorders from surgical procedures, learning disabilities, etc.
First Time Mothers!
This information is for you! Making plans for your first baby in many instances means you are making plans for all your babies! A natural birth, the first time increases your chances of the same for the following births!
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 Low-risk babies born to healthy mothers by caesarean surgery are 3 times more likely to die in the first year compared to babies born vaginally.
INDICATIONS FOR CESAREAN BIRTH: WHAT CONDITIONS CAN LEAD TO THIS TYPE OF BIRTH?
It is never certain during pregnancy if a clinical need will arise for your baby to be born via c-section. It is important to maintain optimal health (as discussed later) for a healthy pregnancy and birth.
REASONS FOR CESAREAN BIRTH FIT INTO THREE CATEGORIES:
1. URGENT HEALTH SITUATIONS:
In a small percentage of pregnancies situations can arise where immediate c-section is required. For example extreme blood loss in the mother (haemorrhage); or if the babies’ oxygen supply is blocked, for example: A cord prolapse or when the placenta prematurely separates from the uterus (placental abruption).
2. NON-URGENT HEALTH SITUATIONS:
Your caregiver might recommend a c-section for certain non-urgent medical reasons. These reasons only increase the possibility of having a caesarean delivery and can occur before or during delivery, some women in these situations will have a caesarean birth and some will not.
Women who are advised caesarean sections because of the following reasons should explore all their options since medical opinions differ in
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these areas. Seek a second opinion or find a doctor willing to do a normal delivery under these circumstances:
• Previous Cesarean birth: This does not always mean another cesarean will be necessary. Educate yourself about the possibility of having a VBAC (Vaginal Birth After Caesarean), find a supportive health care provider and educate yourself.
The World Health Organization states there is no evidence that a caesarean section is required after a previous transverse low- segment caesarean. Given the increased risks of multiple abdominal cesarean surgeries, VBAC is statistically proven as safer and is also possible after more than one cesarean surgery.
Most women attempting VBAC will have a vaginal birth! The VBAC success rate can be up to 85% with doctors and midwives who are truly committed to VBAC. This can proceed like any normal birth; medications to start and speed up labor should be avoided.
• Failure to progress and prolonged pushing during birth: Many doctors put strict time limits on birth, birth takes time! If the mother and baby are both doing well there is no reason to decide on a cesarean. Slow ‘early labor’ is often wrongly considered ‘stalled’ labor, but truly this is a normal process of birth, in most cases labor will restart when the body and baby is ready. A lot of support, commitment, hydration, food, relaxation is required for long or stalled labors, it is important to plan ahead for this situation; an experienced birth companion can be very helpful.
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• Breech position: It depends on how your baby is positioned and the experience of your doctor/midwife. Studies show with a skilled caregiver, a breech vaginal delivery can be as safe or safer to mother and baby as a cesarean birth. Turning the baby is the best way to avoid a cesarean and there are many techniques available to turn breech babies to a vertex, or head down, position.
 Changes in baby’s heart rate: Babies are designed to undergo the stress of normal labor; the heart rate can often fluctuate but still be within the normal range. Interventions such as synthetic Oxytocin (used to induce or speed up labor) can cause changes in the heart rate. The World Health Organization (WHO) recommends intermittent (not constant) monitoring of fetal heart rate with a doppler or fetoscope, for best outcomes. At times bringing fetal heart rate into safe parameters can be as simple as having the mother change position and get hydrated. Learn about preventable causes of and non-invasive treatments for fetal distress prior to birth.
 Multiple Births: There is no strong research supporting routine cesarean for women carrying twins.
 Post dated pregnancy: The duration of most pregnancies is 38-42 weeks. Not going into spontaneous labor by your due date is not an indication for a c-section. Try natural means of induction first.
THE COMMON REASONS STATED SUCH AS IVF (IN VITRO FERTILIZATION), FIBROIDS, ADVANCED MATERNAL AGE, BEING OVERWEIGHT, SMALL STATURE, ‘SMALL PELVIS’, POSTERIOR POSITIONED BABIES, FETAL HEAD NOT ENGAGING, WATER BREAKING AT TERM, DIABETES AND GESTATIONAL DIABETES, MECONIUM, ‘BIG BABIES’, AND A CORD AROUND
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THE NECK ARE NOT INDICATIONS ON THEIR OWN TO UNDERGO A CESAREAN SURGERY. GET INFORMED!
"It is now accurate to say that many interventions and medications used in birth are used routinely or frequently in spite of research that has clearly shown that they are being used inappropriately." Judith Pence Rooks, author of “Midwifery and Childbirth in America”
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3. NON-MEDICAL SITUATIONS (ELECTIVE CESAREAN):
There are many myths surrounding vaginal childbirth, including:
 Cosmetic: Many women are led to believe that a natural vaginal birth will cause urinary incontinence later in life, or that they will become ‘stretched out’ and therefore not be able to enjoy love making. These are only MYTHS. The perineum is elastic and designed to revert back to its natural elasticity, pre and post natal yoga, and other natural care techniques have proven this. Getting enrolled in a good prenatal class or consulting child birth educators, teaches mums to care for their body in the optimum way. Get informed!
 Convenience: Some women want to choose a cesarean birth for convenience; i.e.: they can choose a time and day (auspicious times) cesareans are not a ‘pain-free’ way to give birth. Get informed!
 Fear of Birth: Support, counseling and preparation can all help to release fear of vaginal childbirth. Get informed!
 Safer: This is a MYTH that caesareans are actually safer for mother and baby and are preventive of complications that may occur during a natural labor. Get informed!
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HOW TO AVOID MEDICAL BIRTH AND C-SECTION
Adapted from a previous publication in the Twin Cities, MN, and USA Childbirth Collective Newsletter:
• Choose a doctor or midwife who supports your birth wishes. This is one of the most important choices you will ever make.
• Educate yourself and your partner, choose independent birth educators, explore all your available options even the unconventional. Learn about good nutrition during pregnancy. Exercise and get sunshine daily.
• Get prenatal massage or other bodywork and learn about how to techniques for optimal fetal positioning. Get psychological help if required to address fears and other issues.
• Avoid common medical interventions. Investigate alternatives, non invasive pain relief methods and comfort options prior to labor
• Refuse I.V and any medications to start and speed up labor or give pain relief, when in hospital. Try natural remedies.
• Labor at home for the early stages (if you live close to the hospital), if you reach the hospital and you are less than 4cm dilated return home.
• Whenever possible take a doula with you for labor support.
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WHEN CESAREAN DELIVERY IN NECESSARY, HOW TO ADVOCATE FOR HEALTHIEST RESULTS?
Health can be present with you even in a surgical procedure; this will assist in a quick recovery for you and baby.
-Spinal anesthetic is preferable to general anesthetic
-Support person to be allowed in the operation theatre
-Immediate (cheek-to-cheek) contact, even for just a minute with your baby after birth, breast feeding can be initiated even in the operation theatre if mum and baby are in good health or at least immediately after mom reaches the recovery room
-Double layer suturing of the uterus for closure of incision.
-Ensure the curtain is used to obstruct view of the surgery to the mother helping her remain calm.
-Allowing the placenta to birth naturally.
-Delay cutting of the umbilical cord and cleaning of the baby immediately post partum. This is the time to establish bonding and attachment between mum and baby, or if mum is unavailable then between father and baby.
-Ensure to eat and drink well and get good rest. Be kind to yourself and take good care of yourself for the following 6 weeks and allow your body to heal. Arrange for as much help and support for domestic chores.
-Talk about your feelings with your support people post birth
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- Heightened emotions, weepiness and moodiness are all natural processes of the nervous system turning back to its equilibrium. Allow it and support it. It can prevent post natal depression.
Just as a woman's heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth. -Virginia Di Orio
FOR FURTHER INFORMATION:
www.ican-online.org
www.childbirthconnection.org
www.vbac.com
http://vbacfacts.com
www.cares-sa.or.au
http://www.unnecesarean.com
Write to Birth India to access other information brochures, books & films library.
BE THE CHANGE!
Write to you care provider OB.GYN or midwife, childbirth educator, the director of nursing, pediatrician, anesthesiologist and hospital owner or administrator let them know what you were happy with and what could be improved upon.
BIRTH INDIA
india.birth@gmail.com
www.birthindia.