Written by Shay Gabriel

cesarean birth is birth

Whenever we talk about cesarean birth, you'll find a common theme in our language: Cesarean birth is birth. We believe this value is important to acknowledge in order to promote and protect the dignity and respect of each and every person who experiences a cesarean birth, whether elective, emergency, or anything otherwise. We envision a world where birth institutions honor informed choice, birth values, and promoting gentle, family-centered cesarean births. Read along with us as we delve deeper into cesarean awareness & share beautiful images of belly births!

“whatever it takes to get baby here safely”

"Whatever it takes to get baby here safely." If you've uttered these words, perhaps you've experienced that moment when the OB begins to talk you through an unexpected transfer to cesarean. And here's the thing — we can both mean those words with every fiber of our being *and* grieve the loss of the birth we'd envisioned. There's a wide range of experiences here, but know this: if you have difficult feelings around having had a cesarean birth, you are not alone. Consider joining a support group near you, writing your birth story, reflecting on your birth photos, debriefing with your birth team, and/or meeting with a therapist. Postpartum is a beautiful, complex, often unpredictable time of great change. We believe your postpartum care matters just as much as everything leading up, no matter your birth story.

why the need for awareness?

It's essential to acknowledge that cesareans can be life-saving & necessary & worth the risks involved. It's also essential to recognize cesarean birth as birth & to honor it as such. Please keep these perspectives in mind as you read the following:

"Researchers estimate that almost half of the cesareans performed could be safely prevented."
"Cesareans can be more or less 'family friendly' depending on the practices and protocols at a facility and provider support."
"If families don’t know [what] options exist they can’t advocate for them."
"Often the future risks to birthing people, and their future pregnancies and children are not even mentioned."
"Preventable Cesareans may be responsible for up to 20,000 major surgical complications a year, including sepsis, hemorrhage, and organ injury."

(International Cesarean Awareness Network)

Remember, while cesareans are major surgeries, they can be life-saving & necessary. Every family deserves the right to clear, upfront information about risks, benefits, & alternatives. And cesarean birth is birth, whether elective, emergency, or otherwise.

what impacts cesarean rates?

The cesarean rate in the United States has hovered around 1 in every 3 births. Does this mean that 1 in every 3 babies could not have been safely born vaginally? No, not exactly. It's a complex topic impacted by cultural norms, institutional practices, the cascade of interventions, and more. We’ll cover some key points. We share this information because we believe that in order to truly embrace your right to informed choice, you must first be informed. Understanding what commonly occurs can help you make your own informed decisions + better support your desired birth outcomes *and* can help you come to terms with any changes of plan, as an empowered, active participant.

“The continuous one-to-one emotional and physical support provided by doulas can reduce cesarean rates.”
“A 2021 retrospective population-based cohort study found HBAC [home birth after cesarean] is associated with a 39% decrease in the odds of having a [subsequent] cesarean.”
“The lack of resident training programs to teach new physicians to confidently and competently attend vaginal births of breech, multiples, or other potentially challenging deliveries is a driver in the increasing rates of cesareans.”
“Cesarean rates widely vary across settings and countries, which seems to indicate the prevalence is not based on medical necessity. [e.g.] Brazil is not inherently more likely to have higher rates of people in need of medically necessary cesareans.”
“The Cesarean rate in the United States has remained essentially stagnant since 2010. despite the tireless efforts of advocates. Transparency of facility cesarean rates, and accountability for both providers and facilities is needed.”
(International Cesarean Awareness Network)

Risk of uterine rupture is often cited as a reason why a provider may discourage or deny care for a VBAC (vaginal birth after cesarean). Risk of uterine rupture rates are as follows:

Trial of labor after Cesarean: 0.47%
Elective repeat cesarean: 0.026%
Induction with Pitocin: 1.1%
Induction with prostaglandins: 2%
Induction with misoprostol: 6%
Augmenting labor with Pitocin also increases the baseline risk.

(Evidence Based Birth)

Contraindications [for a VBAC] include having a prior classical or inverted T uterine scar, a previous hysterectomy or myomectomy entering the uterine cavity, a prior uterine rupture, a presence of a contraindication to labor such as having placenta previa, or a baby in transverse lie position, or someone who was declining a VBAC and requesting a repeat cesarean (Evidence Based Birth).

provider interests & the cascade of interventions

We encourage birthing persons and their families to be mindful of common circumstances in which cesareans are sometimes pushed for reasons other than medical indication, including provider vacation time, hospital shift changes, higher rates of pay for providers, agendas tied to liability insurance, etc. Ask questions, require clear communication that honors your right to informed consent, and remember the BRAIN tool.

It's also important to note the "cascade of interventions" here - the concept that one intervention can lead to another, which can lead to another, and can ultimately lead to cesarean. It’s not uncommon for providers to press the topic of induction, even well before a pregnancy reaches 42 weeks. Induction is often discussed as if it’s simply a remote control starter for a running vehicle — just press this button, and everything else will follow! While that may be true in the best of cases, the reality is that induction can conflict with the body’s natural preparations for labor. It would be like pressing the remote control starter for a car whose battery still needs to charge, for example.

When physiology is replaced by medical management, it can change the course of labor and birth. For example, induction of labor can lead to more intense contractions, which can lead to epidural, which can affect the efficiency of contractions and therefore leads to Pitocin, which can intensify contractions and baby's heart rate and lead to cesarean.

Doula Support

Having a doula on your birth team, particularly in hospital, is shown to reduce rates of cesarean. While the presence of a doula matters, part of this reality rests in what's described above: doulas promote becoming informed. Being informed means actually knowing what your options are and how to better advocate for your birth wishes leading up to birth. Our doulas advocate for you and your birth wishes, too. You do you, and we've got you! And sometimes, unplanned cesarean birth still happens. Cesareans are an incredible medical intervention that can and do save lives. They are also intense surgeries that need not be pushed only because your OB wants to head out on vacation. Birthing person and baby come first!

gentle cesarean / family-friendly cesarean birth

You may have heard the terms "gentle cesarean" or "family-friendly" cesarean — or many other similar phrases that imply the same bottom line: putting power over the birth experience back into the hands of the birthing person. With birth in general, you have the right to informed choice. But how can you advocate for your choices if you don't know what your options are? Ideally, providers will tell you, clearly and carefully. Realistically, it often rests in the hands of the birthing person/family to learn what their options are and advocate for them, as providers tend to default to their own/the institution's set of standard routines.

Here are some descriptions of “gentle” or “family-friendly” cesarean births; note that options may vary by location, and you may need to advocate for your interest in any of the following:

Considering the risks and benefits of the potential for the birthing person's body to begin labor naturally before a planned cesarean takes place
When time allows, encouraging the birthing person to calmly discuss cesarean with their unborn baby. The process will help calm both birthing person and baby as physiological responses shift with mindful preparedness.
Allowing a doula to provide continuous support in the operating room
Allowing a birth photographer or their camera in the operating room to continue documenting the birth
Walking into the operating room on your own, if possible, and having everyone introduce themselves by name and role. Birthing persons might find this to be an empowering way to enter the space.
Allowing the birthing person to play a playlist of music or meditation tracks of their choice in order to feel more relaxed and positive
Allowing the birthing person the opportunity to use alternatives to medicine for nausea-reducing methods (such as smelling peppermint oil on cotton ball that can be easily removed)
Honoring the birthing person's wishes for a clear drape, or lowering the drape upon birth so the family can watch their baby be born without watching the surgery
Respecting the family's wishes around identifying the sex of the baby, if unknown. Does the birthing person want it announced? To discover it on their own?
Honoring the family's wishes for delayed cord clamping as the family has defined it (until pulsating stops, until the cord is white, after a certain amount of time...) as long as baby is stable
Offering immediate skin-to-skin
Offering vaginal seeding
Keeping vernix on baby, rather than wiping it off
Welcoming skin-to-skin while incision is being closed (or encouraging birth partner to do skin-to-skin at that time)
Respecting the birthing person's choice to not have uterus exteriorized during the procedure (in case that's still practiced). Consider asking that your uterus be double-sutured to increase the odds a provider will support a VBAC in future.
Considering the opportunity to breastfeed in the OR
Honoring requests to delay all possible newborn procedures until after having settled into the designated recovery room and having had a chance to breastfeed and bond

Remember, part of a quality doula's role is to help educate and inform you so that you are empowered to make the decisions that feel best for you in the circumstances that unfold. Cesarean birth isn't always discussed beforehand when it isn't planned, so if you're curious about your options and want to consider how to prepare clear birth wishes for a hospital team should you undergo cesarean, have a talk with your provider and doula, and check out the many resources available online when you search "gentle cesarean" or "family-friendly" cesarean, for example. You’ll also find that many of your birth wishes for a vaginal birth can carry into the OR, such as delayed cord clamping and immediate skin-to-skin.

birth on your own terms

Wherever and however you give birth, we wish you an empowered experience where your rights are honored and you are supported to birth on your own terms!

If you’re local to West Michigan and interested in birth doula support, birth photography & films, postpartum doula support, or lactation support, connect with us here! We can’t wait to support you.

Shay Gabriel is the content director at Sprout and Blossom whose love of parenthood and psychology has merged into a super-obsession of all things birthy and baby. She believes an informed experience lends to an empowered experience, no matter where you are along the journey.