OK, we always have to start with what a cesarean is and why we don’t want them to happen unexpectedly- if at all! Other names cesareans may be called are c-section, cesarean delivery (CD), and cesarean birth (CB). So, while this information may seem like repetitive blah blah blah, it is still important to know that a CB is more than just a “major abdominal surgery.” This surgery actually has a lifelong effect that you may not know about! CB, also known as a C-section, is when a baby is born through surgical incisions in the abdomen and uterus. 

Planning for a CB might be necessary if your provider or hospital doesn’t support vaginal birth after cesarean birth, so a repeat cesarean is required, if the baby is in the breech position, or there are multiple babies such as twins, triplets, or more and your provider chooses CB over breech or multiple pregnancy vaginal delivery. If there are certain complications in pregnancy such as placenta previa (where the placenta covers the opening of the cervix and can put a mother and baby at risk for hemorrhage), there is a health concern for the mother such as a heart or brain condition, or possibly there is a blockage such as a large fibroid, pelvic fracture, or severe hydrocephalus, this can also indicate a need for cesarean birth.

Often, however, the need for a first-time CB isn't clear until after labor starts. Cesarean birth could be necessary in an emergent event, such as the baby is in distress, the heart rate is dropping, and the baby must be rescued. Or the umbilical cord slipped through the cervix and is now in front of the baby, which is a life-threatening event to the baby, called an umbilical cord prolapse.  

But one of the most common reasons for a CB is when labor doesn’t progress (labor dystocia). Types of labor dystocia include a prolonged first stage (prolonged dilation or opening of the cervix) or prolonged second stage (prolonged time of pushing after complete cervical dilation). The more CBs a woman has, the greater the risk of problems she may have with future pregnancies.

Like other types of major surgery, cesarean births carry risks for mother and baby. Let’s start with separation of mother and baby after CB- which can interfere with bonding between the two. There are times when the separation ends up being longer than expected due to a risk of breathing problems babies can develop after a cesarean birth that may necessitate a stay in the Neonatal Intensive Care Unit (NICU). No mother wants to be separated from her baby after birth, and it has been documented that it has a direct link to postpartum depression for the mother and future phycological issues for the baby. I talk about that in my blog, THE INVISIBLE PROCESS AFTER BIRTH. 

A cesarean birth also puts a mother at risk for a post-operative infection at the incision site, the uterus, or in the urinary tract. Blood loss is always a concern in any surgical case, and a hemorrhage can make a mother feel extremely tired and weak. She may also experience a delay in milk production because her body will have to repair itself and recover its volume from the blood loss. What makes a cesarean unique is that it is one of the only major surgeries where the patient (mother) is expected to care for her newborn after her surgery, when other types of surgeries standardly recommend the patient have ample time to recover, relax, and rehabilitate. 

Surgery has risks itself, it doesn’t matter what kind. There are always risks for life-threatening blood clots that could travel through the circulatory system and into the heart or lungs and could cause a fatal injury. There is also risk of unintentional surgical injury to other parts of the body, including the bladder and bowel. Sometimes reactions to anesthesia can occur as well, such as malignant hyperthermia, which is a severe reaction to certain drugs used for anesthesia. This severe reaction typically includes a dangerously high body temperature, rigid muscles or spasms, a rapid heart rate, and other symptoms. Without prompt treatment, the complications caused by malignant hyperthermia can be fatal.

Having a cesarean birth has a serious impact on future pregnancies. A big concern is the increased risk of a uterine rupture, which is when the uterus spontaneously tears open and as a result, the fetus is potentially expelled into the abdominal cavity. This is a rare event, but a previous cesarean birth increases your risk because the uterine scar tissue from the previous cesarean birth is weaker than the original uterine muscle itself. It can occur anytime during late pregnancy or while in active labor. 

https://healthjade.net/uterine-rupture/

Did you also know that the more CBs you have, the higher your risk of placenta previa and placenta accreta? We talked about placenta previa, but what is placenta accreta?

Placenta accreta is a high-risk pregnancy complication that occurs when the placenta becomes embedded into the uterine wall. It can cause not only a severe and life-threatening hemorrhage, but also possibly an emergent hysterectomy to save your life, depending on how deeply the placenta is embedded. Unfortunately, it is often hard to determine whether a mom has placenta accreta before birth, but ultrasounds and MRIs may be able to help diagnose it in some cases. Additionally, certain risk factors such as age, previous cesarean births, and smoking could increase one’s chances of developing placenta accreta. 

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https://www.babycenter.com/pregnancy/health-and-safety/placenta-accreta_10407873

 And here are some stats: 60% of all CB are PRIMARY cesareans. And of this group of women, only 10% will go on to have a vaginal birth after cesarean (VBAC). That means 90% of all women who have had ONE cesarean, will end up having a repeat cesarean. The more CBs you have, the recommendation and support for a VBAC proportionately decreases. This is another reason why avoiding the first cesarean is so important. The question is: HOW? 

How do you prevent or avoid a cesarean that is caused by preventable causes, like labor dystocia??

Here is where it gets exciting! Hang on to your hats, this information is going to blow you away!

#1 PREPARING THE SOFT TISSUE OF THE BODY

What is Soft Tissue

Soft tissues connect and support other tissues and surround the organs in the body. The soft tissue structures in the body include muscles, tendons, ligaments, and their protective covering, known as fascia. When these structures become tight, it can impair mobility and cause pain. 

Soft tissue mobilization (STM) is a form of manual therapy treatment where a variety of pressures and stretches are applied to the muscles and fascia. This can temporarily improve blood flow, reduce swelling, reduce pain, and improve mobility and muscle function.

While traditional massage is aimed at working out stress in the body, STM is directed at restoring normal function to the affected structures.

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WHY DOES IT MATTER TO PREGNANCY?

Many people are affected by restricted soft tissue without them even knowing it, but once a woman’s body begins to grow with her pregnancy, the restrictions can become evident when she feels aches and pains. Or maybe there is no obvious pain, but she feels uncomfortable during the pregnancy. The restricted soft tissue may cause difficulty for the baby to rest in an optimal position. 

The baby may have to sit in a breech position (baby is head up instead of head down) or maybe an occiput posterior (OP) position because the tissues will not stretch to allow for free movement of baby. OP is the most common fetal malposition (UpToDate), where the baby faces toward the mother’s stomach rather than her backside. Facing toward the backside is called occiput anterior and it is considered the optimal position. Understanding OP position is important because it can be associated with labor difficulties if the mother does not have the pelvic shape needed to birth a baby in this position easily. This may lead to adverse maternal and neonatal consequences, particularly operative vaginal birth or cesarean birth.

A mother may not even be aware of the baby’s position or the condition of her soft tissue until labor begins. She may experience a long, difficult, and painful early labor phase, known as prodromal labor. Or, when in active labor, her dilation and descent can be slow, or possibly stall out altogether, in which she stops dilating, or the baby does not descend through the pelvis even when fully dilated. This is called arrest of dilation or progression, and it is the number one cause of the primary cesarean (Caughey et al., 2014).

The baby could be in the right position for the mother’s pelvis, but the soft tissues could be so tight and restricted that the tissue directly surrounding the pelvic bones will not allow the necessary mobility the pelvis needs to help the baby navigate through the birth canal.  

Receiving STM work throughout pregnancy will allow for functional mobility, a more comfortable pregnancy, and an easier, shorter labor and birth. 

Types of Soft Tissue Mobilization Therapies include but are not limited to:

• Structural Integration (some just call it Rolfing)
• Myofascial Release Therapy / Massage
• Osteopathic work
• Trigger Point massage
• Muscle Energy Technique
• Positional Release Technique

Scar tissue work is important to receive as well. If you are planning to VBAC, read my ALL ABOUT VBAC blog for helpful tips! 

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Chiropractics

Not only can routine chiropractic care help manage pain in your back, hips, and joints, it can also establish pelvic balance. That can provide your baby with as much space as possible to settle in the optimal position and lead to a faster, easier labor and delivery.

Using STM and Chiropractics are extremely synergistic in keeping your body feeling good in pregnancy, and helping with a faster, easier labor and birth. 

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#2 MOVEMENT

After receiving bodywork in pregnancy, maintaining all of your hard work is important. You can do this through consistent stretching and movement. Prenatal yoga is an extremely effective way to keep the balance to your body in between bodywork and chiropractic sessions, as well as teaches you how to breath with movement. 

Try at least 30 minutes of movement each day. You don't need to do extensive workouts to see the benefits of exercise. Prenatal yoga is a low-impact fitness routine that can help increase your strength and flexibility, while decreasing lower back pain and other common symptoms of pregnancy.

Avoid reclining on your back during pregnancy. Instead, position yourself in a more forward position. This promotes great blood flow, but it also helps avoid an OP positioned baby. The baby’s back is the heaviest part of their body, and as you spend more time leaning forward, you can use gravity to help encourage the baby to nestle their back into your belly. It is good to limit reclining positions after around 32 weeks if you want to try and avoid a posterior positioned baby. Forward leaning or abdominal lying positions can use gravity to encourage your baby into an OA, aka OPTIMAL position. Point of this story: stay out of those recliners as often as you can. 

And of course, utilize those upright positions and movement during your labor. Walks, squats, using the birthing ball, dancing, side-lunges, pelvic tilts or Cat/Cow, and moving your hips in a figure 8 pattern are all great movement ideas. Remember though, resting is just as important! So, alternate your rest with your movement exercises. Keep stretching in labor as well. The muscles will get tight especially if you forget to breathe! 

Safety Considerations

Movement and exercise are great ways to stay healthy during pregnancy, but pushing yourself too hard has no benefit. Even if you exercised before pregnancy, you should still talk to your doctor before beginning any prenatal yoga routine. Watch for signs like sharp pain with certain movements, vaginal bleeding, or decreased fetal movement. If a movement or posture doesn't feel good, slowly bring yourself back to a comfortable position.

#3 MINDSET

The mind is the most powerful tool you have to make anything happen in your life, wanted or unwanted. The fact is, THOUGHTS BECOME THINGS. Whatever our dominant thought is, it will come to pass. If you are thinking how scared you are, or how much you don’t want a cesarean, even though you don’t want them, YOU ARE THINKING THEM! 

The key is how you think and feel. Thoughts create feelings, feelings create action, and action creates a reaction which ends in a result! If you the result you want is a safe, happy, easier birth, then you have to think about a safe, happy, and easier birth. This may take some practice if you are not used thinking about what you want instead of what you don’t want. This is something we work together on in The Natural Birth & Beyond Method, a program I developed to help mothers overcome physical and invisible barriers to achieving the birth of their dreams. 

When you really understand how the conscious mind and the subconscious mind work, you will use affirmations more effectively and better than you ever have before. This will sooth any fear, doubt, and worry you may be harboring, whether consciously or unconsciously. 

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This may be another area where you can introduce prenatal yoga or medication to reduce stress and symptoms of depression and anxiety. Breathing in slow, rhythmic breaths activates the nervous system and blocks cortisol, which, in high amounts, has been linked to depression.

Meditation and breathing exercises have been shown to reduce pain and anxiety during labor. Being confident and building your coping abilities will also help you have a less painful labor experience.