Choosing Cesarean or Labor - Understand Your Options

Each person’s experience and medical needs are individual.

You may be told that a cesarean or a vaginal birth is the safest option for you. While for most people a vaginal birth is safest, an individual is not “most people.” Because each of our body’s needs are individual the ultimate responsibility is on ourselves.

Some of the parents coming to our website are especially determined to have a vaginal birth. When the determination to avoid a cesarean is high, it’s normal to question whether advice for a cesarean is relative or absolute.

Give yourself permission to see if your expectations and desires match the medical needs of you and/or your baby. Today, the accepted reasons for a surgical birth are so common that it can be a challenge for parents to discern where the recommendation falls between recommended or absolutely medically necessary.

Your doctor will have a conversation about the risks and benefits of a cesarean. This is the “informed consent” conversation. Look below for tips to your portion of the discussion in case you want more information during this vital conversation.

The most important variant in accepting a cesarean that may not be absolutely medically necessary is you. Sometimes accepting a surgical birth is practical even if a vaginal birth may be possible. It’s not the place of Spinning Babies® to decide. If you want advice you might seek the support of professionals and activist who share statistics. I write for your reflection, not for statistical likelihood. Others do that job and I refer you to their up-to-date info. (Childbirthconnection.org, Evidence-basedbirth.org)

When challenged by the recommendation of a cesarean, keep the conversation open between you and your provider. Closing down, a coping technique to reduce stress, is actually disempowering. So is out and out resistance. Rather seek to engage a conversation as equals with the understanding you are both seeking the choice that protects you and your baby. The strategies are different but the goal is the same.

To keep the conversation open, add a third element. The need that has arrised. Let’s say the need is the baby’s breech position needs more skillful care for birth than a head down baby. In the birth setting you chose or you find yourself in, the skill in a safe cesarean may be higher than the skill of the doctor for a vaginal breech birth. The risk is seen as higher than a head down baby’s vaginal birth and experience with vaginal breech birth is scant. A cesarean is offered as a solution. You have needs to know your baby is ready to be born or has benefits of labor. You express that. Perhaps a mutual solution is to do the cesarean when labor begins.

In some settings, like rural hospitals, this may not be practical. You may accept the cesarean at a later gestation or you may decide to travel. The solutions you choose are more appropriately chosen when you are aware of your needs and to be honest, the needs of your provider. It’s not wise to push a provider into a situation where they are unable to meet your needs.

The dialogue between equals who hold each other in high regard can discover needs and find creative solutions to meet the need or compromise.

If you have questions about a recommendation for a cesarean

Do you understand and accept why? If so, then move to the next question.
If you don’t understand why, ask. You may design your questions around asking for the following five areas of decision making:

- Benefits
- Risks
- Alternatives
- Intuition
- Nothing

If medical action is warranted, then instead of doing “nothing” ask about “Next Steps.” If you have time to try something from Spinning Babies^® website, this would be discovered in the Alternatives and the Nothing portions of the informed consent conversation.

3. What if, after the discussion of Benefits, Risks, and Alternatives, you don’t feel that the recommendation of surgery is right for you?

You may either find another care provider, or ou may give yourself compassion for accepting a surgery that you aren’t entirely in agreement for. You are giving birth with a birth team that may have differing opinions. It’s a natural feeling to agree with the person you chose to guide you through birth safely. There may be some grieving even as you see the practicality of going with a surgical birth.

In rare cases, parents may look for another provider or even another hospital or provider.
It’s not uncommon to have mixed feelings while accepting the cesarean.
Check in with yourself. Acknowledge your feelings, whether or not you seek other opinions.

Whatever you decide, I hope you look back a year from now and feel listened to, empowered, and satisfied with your choices. You get to choose.

Planning for a cesarean

There are ways to make your cesarean more family-focused.

Talk to the anesthesia department at your hospital to discuss personal adaptations to your needs. For instance, do you want your doula to be present with your mate/partner/husband during the surgery?

Do you want to give your baby the benefits of skin-to-skin contact?

Ask ahead of time for as many physiological accommodations as possible or achievable, such as delayed cord clamping, skin-to-skin contact on the operating room, breastfeeding in the Recovery Room, doula presences in the Operating Room and/or in the Recovery Room.

After the cesarean, you can create an intimate skin-to-skin welcome of your new baby or babies. Holding the baby is a wonderful way to reestablish a calm welcome and go for an extra hormonal “bonding” surge after a busy beginning in the Operating Room. Ask your doula, partner, family member or nurse to help you!

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