The C/section rate in Virginia was recently 35%. The C/section rate at Loudoun Hospital was 32.5%. At Loudoun Community Midwives, our total c/section rate runs about 12%. This includes women who had a previous c/section and asked to avoid labor, and also women with breech babies, requiring c/section delivery. With women who had an uncomplicated pregnancy and then labored, our rate of c/section is 9- 10%. This is very low, but it’s not zero! C/sections can be necessary, and they do happen, even when least expected.
The most common reasons for c/sections are:
- Dysfunctional labor,
- Concerns for baby’s well-being
- Long, poorly progressing labor,
- Mother running a fever,
- Concerns over baby’s heart rate
- Other stress indicators
These things can lead us to discuss c/section birth. Sometimes C/sections are complete emergencies, but most often, we have plenty of time to discuss options and answer questions.
We try to avoid c/section in many ways: We encourage walking, relaxation, and position changes throughout labor, including pushing. We patiently allow labor to progress at a natural rate, as long as it’s progressing and mom and baby are doing well.
We DO SOMETIMES recommend interventions such as Pitocin augmentation and/or epidural, when progress is minimal, to avoid maternal exhaustion and to accomplish the birth vaginally before stress occurs. We hope at times like those, the midwife’s experience and advice will be trusted. Women who have a c/section in our care say that they feel we tried everything else, and that they had power, information, and emotional support, throughout.
The CNM usually goes to the Operating Room with you, and participates in the surgery, unless other labors conflict. Prior to going to the O.R., a catheter is inserted to keep the bladder empty, a small shave is done on the pubic area, antacid liquid is administered, and consents are signed.
Almost all our C/sections are done with spinal and/or epidural anesthesia, so mom can see and touch her baby when he is born, and the baby stays with the parents in the Operating Room and Recovery area, if all is normal. Mothers are helped to breastfeed as soon as possible in the recovery area. Most babies nurse just fine after a c/section birth, and all the staff knows you need help to do this. The spinal/epidural gives long-lasting pain relief post-op, then moms begin to take oral pain medicine. Later the mother will be assisted out of bed to walk to the bathroom on her own
Most mothers go home on the third day after a c/section, and may stay 4 nights if they need to. LCM midwives will consider a trial of labor (TOLAC) and future vaginal delivery (VBAC) for you, if you had a c/section for what could be considered a “non-repeating reason”. It’s a topic for later discussion, based on each individual case, and the family’s wishes.