March 22, 2014

Let's Talk Cs

Talking about C-sections is always a tricky business. If you’ve never had one, it’s all fine and well. For women who have, and I’m not one, it can be very fraught. I say this because I have personally experienced backlash from someone over their C-section and what they thought I thought about it. I’ve talked to women who were traumatized by their deliveries that ended in C-section. On the other side, I’ve talked to women who, whatever their reasons, have been extremely defensive about their C-section and its necessity.

I bring this all up because I came across a great article today in The Atlantic called “When a Placenta Tries to Kill a Mother.” It’s written by an OB/GYN, and it’s about an extremely dangerous pregnancy complication, often associated with multiple C-sections, placenta accreta. This is when the placenta gets confused, usually when there’s a scar from a previous C-section, and instead of growing and stopping, it grows into, and sometimes through, the uterus itself. This is a life threatening complication for both mom and baby. I have a friend who had this happen to her. In her case, she had one of the most serious kinds where the placenta completely blocked her cervix, grew through her uterus, and had begun to invade her bladder. Yeah, this is some serious stuff. Thankfully, my friend made it through ok, but it was no walk in the park.

It is for times like that that I am forever thankful for modern medicine. This is something that can’t be diagnosed without modern imaging, and it has to be handled surgically, usually with a pre-term C-section followed by hysterectomy. That means no more babies. It’s a very scary surgery that can end in NICU and ICU stays for mom and baby.

This is something that can just happen. But in this day and age, when the most recent CDC numbers put the C-section rate at 32.8% in the US, it is more often than not caused by a previous C-section. And the more C-sections you have, the more likely you are to develop this condition in a later pregnancy. Wikipedia (citing a respected medical journal), tells us that after two C-sections your risk of placenta accreta is 0.13% and after four 2.13%—that’s an increase of more than 16 times.

I am not going to sit here and argue with you about why you might have had a C-section. That’s between you and your doctor. But I am going to advise you that if you did have a C-section, advocate for yourself for a Vaginal Birth After Caesarean (VBAC) for your next pregnancy. The biggest argument against VBAC is traditionally that there is a 1% chance of uterine rupture from the scar. Well, according to a 2010 study, the mortality rate of an elective repeat C-section is 13.4 per 100,000 versus 3.8 per 100,000 for VBAC. That means the woman having the “safer” repeat C-section is 3.5 times more likely to die in childbirth. 

I will return to my mantra. Educate yourself. Trust yourself. It can be hard to find doctors or hospitals that will accommodate VBACs. In my opinion this is for litigious reasons, not medical ones. The argument is often made that it is unsafe to attempt a VBAC unless a hospital has an on call anesthesiologist in case things go south. Well, if the hospital can’t perform a truly emergency C-section, then one could argue, are you safe there at all? If your doctor won’t consider it, find one who will.

I am not saying that horrible things don’t happen. They do. I’ve had some pretty shitty things happen to me, and there’s nothing to be said that’s going to make me feel better about it. I don’t wish a negative outcome on anyone. That being said, don’t choose out of fear. Bad things happen even when we do everything right. That’s not always something we can control. Choosing surgery out of fear because you feel it’s safer or it’s known, might not actually be safer. As the author in The Atlantic wisely put it:

There’s an obvious metaphor here, of course, about pregnancy and motherhood, and how they can devour a woman from the inside. But the setup for a placenta accreta often starts long ago, with a prior pregnancy. The other metaphor is that we carry some of the choices that we make forever, and some of them we never heal from entirely.

Despite all that, your story isn't done. Whatever the past, you can choose for yourself what you want your future to look like. It’s up to you.


  1. Wanting a vaginal birth with twins seems like I'm asking for a lot with my doctors! I had to go with an older doc who has actually done them versus the younger docs who have had no training on them!

  2. This is such a near and dear topic I hold deeply to my heart! And you definitely hit the nail dead on the head here. One other topic that makes me very anti-repeat c-section is because that c-section willing mom is preventing doctors from experiencing more vaginal deliveries and they eventually "forget"/get out of practice in how to do them! My heart hurts when doctors turn away those hoping to have a TOLAC which then forces them to have a repeat section. And don't even get me started on insurance companies, LOL! Great blog entry, Jamie. I'll share this on my doula page. :)

  3. Jenicini: That is awesome that you are going for vaginal birth with twins! I don't know why doctors suddenly decided that women were incapable of pushing out two babies. Even I would probably do twins in a hospital, but I'd definitely fight tooth and nail to try for them the good, old-fashioned way. I wish you the best of luck!


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