One of the fundamental beliefs as midwives, is that a woman’s body is perfect for growing and delivering a baby.
Also, as Midwives many of us (including me) rail against the standard U.S. Medical community for their unnecessary interventions, including the overuse of cesarean section operations. However, as most of us know, we don’t live in a perfect world and sometimes a cesarean section is needed. Recently I had the pleasure of working with a beautiful woman and her family for her prenatal care, labor, and birth. I would like to share one of those reasons through the story of this beautiful couple. This story is told with permission with the names changed. For privacy purposes we will call them Mary and Joseph.
Mary started to have mild contractions sometime on Friday afternoon. She was able to sleep through the night, and the contractions picked up Saturday morning. She went to see her midwife in the afternoon to check on the baby and to see if it was time to be admitted to the birth center. Her midwife let her know the baby was doing great, but it was still a little early. She was sent home to do some exercises, eat a light meal, and rest when needed. Mary’s contractions picked up considerably over the next few hours, were coming at 3-4 minutes apart, and she felt they were very strong. Joseph was concerned and felt it was time to come to the birth center. They arrived at 8pm. The midwife checked for cervical change and found that her water had broken. She had some cervical changes, but it was still a little early. However, the midwife decided to keep them at the birth center to support the couple. Mary labored through the night, but did not show much change in labor patterns, and in the early morning hours her labor stopped. The midwives (we) kept her for a few hours longer. As her labor had stopped and the baby was doing well, the couple was sent home to sleep.
Mary and Joseph slept all day, had dinner, and slept some more. Then, around midnight, her contractions started again. Mary worked hard through the night, with Joseph lovingly supporting her. Joseph felt it was time to go back to the birth center, and they arrived there at 9am on Monday morning. Mary’s contractions were strong, long, and close together. However, she had not made any cervical changes. We decided, since her water had broken and she had had a couple of cervical exams, that a dose of antibiotics we help prevent infection. We also decided together to support her and watch her over the next few hours, and if nothing had changed, we would need to transfer to the hospital. She worked hard for 4 hours with position changes, lots of fluids, and the support of the whole staff. At the end of 4 hours, there were still no changes in cervical dilation, so the decision was made together to go to the hospital. The midwife prepped the couple for the advice that she felt a cesarean section might be necessary. There was something going on to prevent the baby from coming down to progress cervical dilation. The baby had never come down lower during all those hours, and that was unusual.
We arrived at the hospital approximately 30 minutes later. The on-call obstetrician had ordered a room to be ready for her so she was able to come right in without delay. She was, of course, hooked up to all the monitors. Her blood pressure was slightly elevated as she was worried about what was going to happen, but she did say she was “just ready to have her baby.” Joseph agreed. He felt his wife had done enough and was concerned that there had been no progress in 36 hours. The staff and the obstetrician were warm and respectful to Mary and Joseph. Often when being transferred, hospital staff can be insensitive to women who wanted a different path to childbirth. This was not the case that day. The physician did feel a cesarean was necessary, so the couple was informed, prepped and taken back to the OR.
Mary and Joseph had a beautiful baby girl—7 lbs. 14 oz. and healthy.
What the physician found in the surgery was surprising though. She had a “huge” (physician’s words) fibroid at the top of her uterus that was preventing the uterus from pushing the baby down into the birth canal. We were all shocked as this fibroid had not been seen on two previous ultrasounds. She had even been seen at the hospital at 31 weeks for abdominal pain and had an ultrasound then. No fibroid noted on that report either. The couple was so happy to have their baby, thankful that mommy and baby were healthy, and that there was a reason things did not progress. Mary and Joseph did everything right. She had a healthy pregnancy, she ate a healthy diet, and she exercised. Joseph was supportive, ate healthy with her, and exercised with her.
Sometimes we do everything right, and we still don’t get the outcome we want. That’s just how life works sometimes.
Here are some other unusual conditions where a cesarean section may be necessary:
- Severe preeclampsia to save the mother and baby’s life
- Footling Breech presentation
- Transverse lie of the baby at labor
- Uterine anomalies that might prevent normal labor
- Placenta previa-when the placenta covers the cervix
- Maternal/fetal exhaustion (This is often caused by Pitocin induction.)
- Malposition of the baby that prevents descent
- Tight cord around the baby’s neck that prevents descent (A cord around the neck is a variant of normal and the majority of times presents no problems.)
One reason often given to women for a cesarean is cephalic pelvic disproportion. This basically means the pelvis is too small. I don’t believe these diagnoses at all. A baby can get in a position they can’t get out of, but 99.9% of women’s pelvis are perfect. It’s all about the position of the baby, not the pelvis.
According to the World Health Organization (WHO), the cesarean section rate should be less than 15%. In the United States, we range from 20% in California to 60% in some parts of the United States with a country wide average of 33%. We could do so much better with patience and evidenced-based care. Out of hospital cesarean section rate is 6% or less. This care is provided by highly-skilled and highly-trained midwives.
But as this case shows when we do need cesareans; the procedure can be a life saver. Thank God, we have them and well-trained doctors to perform them.
Jaelin Stickels is a Certified Nurse Midwife and Women’s Health Nurse Practitioner. She is currently working at a women’s health clinic and birth center in the Houston, Texas, area as well as running her own homebirth practice. She has a Bachelor’s degree in Nursing from University of Texas and a Master’s Degree from Georgetown; she is currently working toward her Doctorate. She has dedicated nearly 15 years of her life to serving women as a medical professional and is passionate about helping them to be empowered in all aspects of their lives.