What to expect when you're expecting (127 page)

The chances of success are pretty high. About two thirds of all ECV attempts are successful (and the success rate is even higher for those who have delivered before, thanks to those laxer uterine and abdominal muscles). Some babies refuse to turn at all, and a small number of contrary fetuses turn and then flip back into a breech position.

“If my baby stays in a breech position, how will that affect labor and delivery? Will I still be able to try for a vaginal birth?”

Whether you’ll be able to give vaginal birth a chance will depend on a variety of factors, including your practitioner’s policy and your obstetrical situation. Most obs routinely perform a C-section when a baby’s in a breech position (in fact, only 0.5 percent of breech babies end up arriving vaginally) because many studies have suggested it’s a safer way to go. There are some doctors and midwives, however, who feel it’s reasonable to attempt a vaginal delivery under some circumstances (such as when your baby is in a frank breech position and it’s clear your pelvis is roomy enough to accommodate).

The bottom line if your baby remains bottom down: You’ll need to be flexible in your childbirth plans. Even if your practitioner green-lights a trial of labor, it’s just that—a trial. If your cervix dilates too slowly, if your baby doesn’t move down the birth canal steadily, or if other problems come up, you’ll likely wind up having a C-section. Talk the options over with your practitioner now so you’ll be prepared for any possibility come delivery day.

“My doctor said that my baby’s in an oblique position—what’s that and what does it mean for delivery?”

Babies can squirm their way into all kinds of unusual positions, and oblique is one of them. What this means is that your baby’s head (though down) is pointed toward either of your hips, rather than squarely on your cervix. An oblique position makes a vaginal exit difficult, so your practitioner might do an external cephalic version (see
page 318
) to try to coax your baby’s head straight down. Otherwise, he or she will probably opt for a C-section.

Yet another tight spot a baby can get into is a transverse position. This is when your baby’s lying sideways, across your uterus, instead of vertically. Again, an ECV will be done to try and turn baby up and down. If that doesn’t work, your baby will be delivered via cesarean.

“I was hoping for a vaginal birth, but my doctor just told me I’ll probably have to have a cesarean. I’m really disappointed.”

Even though it’s still considered major surgery (and the happiest kind you can have), a cesarean is a very safe way to deliver, and in some cases, the safest way. It’s also a more and more common way. More than 30 percent of women are having C-sections these days, which means the chances that your baby will end up arriving via the surgical route are more than 1 in 3, even if you don’t have any predisposing factors.

That said, if you had your heart set on a vaginal delivery, the news that your baby may need to arrive surgically instead can be understandably disappointing. Visions of pushing your baby out the way nature intended—and perhaps the way you’d always pictured—can be displaced by concerns about the surgery, about being stuck in the hospital longer, about the tougher recovery, and about the scar that comes standard issue.

But here are some things to consider if your practitioner ultimately decides that your baby’s best exit strategy is through your abdomen: Most hospitals now strive to make a cesarean delivery as family friendly as possible, with mom awake (but appropriately numb), dad
in the room by her side, and a chance to take a good look at your baby and even do a little quick kissing and caressing right afterward if there’s no medical reason to preclude it. (More serious cuddling and nursing usually have to wait until you’re in recovery—after you’ve been stitched back up.) So a surgical birth experience may be more satisfying than you’re imagining. And while the recovery will be longer and the scar unavoidable (though usually placed unobtrusively), you’ll also be delivering with your perineum intact and your vaginal muscles unstretched. The plus side for baby in a cesarean delivery is purely cosmetic—and temporary; because there’s no tight squeeze through the birth canal, he or she will have an initial edge in appearance over vaginally delivered babies (think round head, not pointy).

But by far the most important thing to keep in mind as your baby’s arrival approaches: The best birth is the one that’s safest—and when it’s medically necessary, a cesarean birth is definitely safest.

And after all, any delivery that brings a healthy baby into the world and into your arms is a perfect delivery.

“Why does it seem everyone I know (my sister, my friends, plus just about every celebrity) is having C-sections these days?”

With cesarean rates in the United States at an all-time high (over 30 percent of women can expect to have a surgical delivery), just about everyone knows somebody who’s had one. And if the past few years are any indication of future trends, you can expect those numbers to continue climbing—and to hear more and more C-section birth stories from the recently delivered around you.

Many factors contribute to these rising cesarean rates, including:

Safety.
Cesarean delivery is extremely safe—for both mom and baby—especially with today’s better technology (such as the fetal monitor and a variety of other tests) that can more accurately indicate when a fetus is in trouble.

Bigger babies
. With more expectant mothers exceeding the recommended weight gain of 25 to 35 pounds, and with the rate of gestational diabetes increasing, more large babies, who may be more difficult to deliver vaginally, are arriving.

Bigger moms.
The C-section rate has also risen with the obesity rate. Being obese (or gaining too much weight during pregnancy) significantly increases a woman’s chance of needing a C-section, partly because of other risk factors that accompany obesity (gestational diabetes, for instance), partly because obese women tend to have longer labors, and longer labors are more likely to end up on the operating table.

Older mothers
. More and more women in their late 30s (and well into their 40s) are now able to have successful pregnancies, but they are more likely to require cesarean deliveries. The same is true of women with chronic health problems.

Repeat C-sections
. Though VBAC (vaginal birth after cesarean; see
page 325
) is still considered a viable option in a few cases, fewer doctors and hospitals are allowing women to try one, and more are scheduling surgeries over a trial of labor.

Fewer instrumental deliveries.
Fewer babies are being born with the help of vacuum extraction and even fewer with forceps, which means doctors are turning to surgical deliveries more often when they might have turned to instruments for help in the past.

Requests by moms
. Since cesareans
are so safe and can prevent the pain of labor while keeping the perineum neatly intact, some women—particularly those who’ve had one before—prefer them to vaginal deliveries and actually ask ahead for one (see
page 323
).

Be in the Know

The more you know, the better your birth experience will be. And that goes for a surgical birth experience, too. Here are a few topics you might want to bring up with your practitioner before the first contraction kicks in:

If labor isn’t progressing, will it be possible to try other alternatives before moving to a C-section—for example, oxytocin to stimulate contractions or squatting to make pushing more effective?

If the baby is a breech, will attempts to turn the baby (using ECV or another technique) be tried first? Are there times when a breech vaginal birth might be possible?

What kind of incision will likely be used?

Can your coach be with you if you’re awake? If you are asleep?

Can your nurse-midwife or doula be with you, too?

Will you and your spouse be able to hold the baby immediately after birth, and will you be able to nurse in the recovery room?