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Taking the Fear out of a C-Section

Two weeks before my son, Austin, was born, I sat propped up against a sofa in my doctor's office listening to the Lamaze instructor discuss cesarean sections. As she explained to our class of seven moms-to-be that, according to statistics, at least one of us would require a c-section, I was smugly certain it would be someone else. After all, I was only 30, in excellent health, and my pregnancy had been a breeze. It couldn't possibly be me. But then it was.

My labor started as many do. I woke around 2 a.m. to use the bathroom and my water broke. My husband, Paul, and I resisted the urge to dash to the hospital, and I spent the first hours of labor at home. At around noon, with contractions driving me to my knees every two minutes, we headed out. But when I arrived at the hospital, my doctor determined that I wasn't dilating quickly enough (after laboring for nine hours I was only 5 centimeters along) and gave me Pitocin to rev up my labor and an epidural to manage the pain. I dozed for about an hour, only to be awakened by a roomful of people who were all in a big rush.

My doctor sat by my bedside and calmly explained the situation: My son's heart rate was dropping -- his heart wasn't handling the Pitocin as well as it should -- and his head also seemed to be stuck. My baby was in distress and my doctor wanted to perform an emergency cesarean section.

Labor & Delivery: Unplanned C-Section
Labor & Delivery: Unplanned C-Section

Throughout my pregnancy, all I heard was how awful c-sections were and that I should avoid having one at all costs. So as I was wheeled down the hall to the operating room, all I felt was dread. Would surgery rob me of the birth experience? Would my recovery be long and excruciating? Would a long, ugly scar put an end to my days of low-rise Levi's? Ultimately, I was happy to discover that my anxiety was, for the most part, unfounded.

My cesarean was not as dreadful as everyone had warned, and many of my friends report that their c-sections went better than expected, too. In case you need to have one, learn the most common c-section fears and the not-so-scary truth behind them.

Fear #1: I'll have an unnecessary c-section.

Although cesarean births are quite common (about 1 in 4), the decision to perform one is never taken lightly. "If there's any question, the doctor may even bring in another physician and obtain a second opinion beforehand," explains Joan Kent, MD, a New York City ob-gyn.

According to the American College of Obstetricians and Gynecologists (ACOG), there are many reasons why a cesarean birth may be necessary: a large baby; a multiple pregnancy; failure of labor to progress (one third of c-sections happen for this reason); fetal distress; and medical conditions like diabetes, high blood pressure, or placenta previa (in which the placenta covers all or part of the cervix).

"Often several of these factors can occur simultaneously, making a cesarean the safest method of delivery," adds Bruce Flamm, MD, clinical professor of obstetrics and gynecology at the University of California at Irvine. "It's important for patients to remember that the doctor's goal is always a healthy mom and a healthy baby."

Fear #2: The surgery will be long and frightening.

It's normal to be apprehensive of the thought of major surgery. But while you may feel pressure during your cesarean and a tugging sensation when the baby is pulled out, the procedure should be painless and take only about 45 minutes. The baby is usually born in the first 10 to 15 minutes of the operation.

The vast majority of c-sections are performed while the mother is awake and, for pain relief, receives either an epidural or a spinal block, which numbs the lower half of the body. (I was actually numb from my chest all the way to my toes.)

Epidurals are often used for unplanned cesarean sections because most women have already received one during labor. The anesthesiologist then tops off the labor epidural to make it effective during the surgery. Spinals are typically given for scheduled cesareans because they are slightly easier to administer and last only as long as they're needed, about an hour or two. General anesthesia is reserved for emergencies or in rare cases when the epidural or spinal is not working.

Once inside the operating room, the doctor makes an incision just above your bikini line and into the wall of the abdomen. Another incision is made in the wall of the uterus through which the baby is delivered. The umbilical cord is cut and the placenta removed before the incisions are closed.

"After surgery, many patients are given a long-lasting pain reliever called Duramorph, which eases the discomfort after the epidural or spinal has worn off," explains Dr. Kent. Tara Perretta of Sparta, New Jersey, says even though all three of her children were delivered by cesarean section, the births were wonderful experiences, nonetheless: "My husband was always there holding my hand, and since we never knew if we were having a boy or a girl, it was still exciting."

Fear #3: I'll be robbed of the experience of giving birth.

Although c-section moms don't experience a traditional delivery, they are still able to witness the birth of their child and share in those first precious minutes. I remember Austin's birth as one of the best moments of my life. I will never forget the sound of my son's first hearty cries and the sight of his wiggly little body, just a few seconds old, appearing from behind the curtain that hung between my head and the rest of me.

A few mothers I met were disappointed (one mom was even in a c-section support group). But most, like me, were focused on the joy of having delivered a healthy baby.

"I knew I was having a cesarean section," says Heidi Marcus, a Weston, Connecticut, mom, "but I didn't feel deprived at all. I have a wonderful son."

Dr. Flamm points out that women must not blame themselves if their labor doesn't go as planned. "A c-section is not a failure," he says, "even though a lot of medical terminology makes it sound that way."

Sherri Bayles, a New York City-based certified Lamaze instructor, lactation consultant, and registered nurse, agrees: "The important thing is to have a healthy baby -- it doesn't matter how he gets here."

Fear #4: I won't be able to bond with my baby.

If you're awake for the surgery, you can probably hold your baby right away, according to ACOG. And although I wasn't able to hold Austin immediately (my son was whisked away so the pediatrician could check his heartbeat), Paul was eventually able to hold him and rest his tiny head on my shoulder so I could touch him and kiss his cheek.

If part of the bonding experience you envision involves nursing, rest assured that having a c-section will have no effect on your ability to do so. However, you may not feel up to nursing as soon as moms who've had vaginal births.

"After surgery, patients spend about two hours in the recovery room," says Bayles, "and many don't have the energy to breastfeed after that." But if you're game, go for it.

As with all new mothers, it will take a few days for your milk to come in. At first your baby will be getting colostrum, a thin, yellow fluid that contains antibodies. Even though c-section mothers usually take four to five days to produce milk -- rather than the average two to three days for women who have vaginal births -- the colostrum should be enough nourishment until your milk arrives, Bayles says.

Fear #5: The recovery will be painful and difficult.

If there are no complications, c-section mothers typically spend four days in the hospital. During that time, most women experience pain around the incision and find it difficult to get in and out of bed unassisted. But hospitals manage pain very effectively with a variety of drugs. You'll likely be given a prescription painkiller such as Percocet. In some instances you may be given a self-administered morphine drip, which allows patients to receive pain medication when they need it by pressing a button.

You can also do a lot to speed your own recovery. Bayles suggests drinking warm liquids. This will help you pass gas (a sign that your stomach and intestines are back in working order and you can eat) and digest solid foods faster. She also encourages c-section moms to get out of bed as soon as possible, often the day after surgery.

I was reluctant to leave the comfort of my bed that first day, but once a caring nurse bribed me with the offer of a much-needed shower, I was raring to go. Plus, being able to move around helped ease the tightness near my incision.

"You really need to get out of bed, and the only way that's possible is with medication. Don't be afraid to rely on it," Bayles says.

After you return home, take it easy for a few weeks and avoid strenuous activity. I began to feel much better after only one week.

After two weeks, I was strolling Austin through the park. It's important to remember, however, that no two recoveries are alike and that many factors, including your age and previous activity level, can influence how quickly you'll bounce back.

Fear #6: The scar will be big and ugly.

It may be red and scary initially, but don't worry -- you will be left with a thin scar, typically just above the pubic hairline. "Most incisions are typically 5 to 6 inches long to allow the head and shoulders to be delivered," says Dr. Flamm. However, the scar will fade in size and color over time, and most are so low that only your doctor, your husband, and your bikini waxer will ever see it. I actually enjoy looking at my scar every morning when I step into the shower -- it marks the spot where Austin came into our lives.

Fear #7: Once I have a cesarean, any other babies I have must be born that way.

For many years doctors adhered to the "once a c-section, always a c-section" rule, but this is no longer the case today. Having a VBAC (vaginal birth after cesarean) is an increasingly safe option and approximately 70 percent of the women who attempt one succeed.

But it's important to remember that a VBAC is not for everyone. There are serious risks involved and many factors have to be considered by your doctor, such as why the first c-section was necessary, the size and health of your baby, and what type of incision was made on your uterus (this affects your risk of uterine rupture). "It's important to look at each case individually and do what's best for both mother and baby," says Dr. Kent.

Stacey Stapleton is a writer in New York City and mother of one.

Originally published in American Baby magazine, November 2004.