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CHOICES IN CHILDBIRTH

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ESSENTIAL CONVERSATIONS
FOR PREGNANCY, BIRTH AND BEYOND.

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CONSIDERING CESAREAN BIRTH

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TAYO: I think people
sometimes don't understand

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why we are so aggressive

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with trying to reduce
C-section occurrence.

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A lot of folks are like, "C-sections
can be a lifesaving procedure."

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Of course it can.

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Following that lifesaving procedure
are still lots of layers

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in terms of how that person
will be impacted,

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how they will feel about their birth.

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How prepared are we for that person

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to have to go through
a complete bodily transformation

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and be recovering
from an abdominal surgery?

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This impacts her entire family and that
woman's health for the rest of her life.

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IN THE U.S.,
1 IN 3 BIRTHS IS A C-SECTION.

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EXPERTS AGREE THIS IS TOO HIGH.

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What are some of the things
that y'all actually tangibly do

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to support your families
in helping to make sure

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that they avoid
what is truly an avoidable C-section?

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KARIE: So, midwives solely focus
on a vaginal birth.

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And so, in my practice,
we really focused

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on having this collaborative team effort

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with the patient being centered
in their wishes and their desires.

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And so,
we've even incorporated our nurses

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to learn, you know,
techniques about movement.

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We also encourage staying at home
as long as possible,

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in addition to having a doula
to help you while you're at home.

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And when we do that,

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we notice a very drastic decrease
in our C-section rate.

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RESEARCH SHOWS
THAT BOTH MIDWIVES AND DOULAS

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LOWER THE CHANCE OF C-SECTIONS.

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EMILY: What I feel like as a midwife
is most important

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is not necessarily whether a woman
has a vaginal birth or a cesarean

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or an epidural or no epidural,

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but it's that, at the end
of the experience, they feel like

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they were the most important part
of their experience

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and that their voice was heard
and their preferences were honored.

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ANALUZ: Yeah, I think you bring out
a great point.

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And that's something
that we work as doulas with them,

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is kind of plan that out, you know,
and let's help the provider

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learn more about what your wishes
and your wants are.

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YOU CAN MAKE A BIRTH PLAN
TO HELP YOU AND YOUR CARE TEAM

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MAKE DECISIONS DURING LABOR.

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EMILY: One of the reasons our practice
has a low cesarean section rate

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is because we're extremely patient
with our labors.

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Research is really supporting that,

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allowing time for a longer labor,
a longer pushing phase,

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as long as mom and baby
are both doing well.

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Because of the potential risks
of repeated cesareans,

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it's really important
that we help prevent

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the first cesarean if it's unnecessary

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because a first cesarean
does significantly increase the chance

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that a woman will have a cesarean
with her subsequent deliveries.

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So, one of the things I tell women who
want to prevent an unnecessary cesarean

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is to have midwifery care
because that has been proven

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to reduce C-section rates,
in addition to having a doula's support.

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ANALUZ: That's one of the things
that we tell our clients as well,

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and how beneficial it is
to their health.

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Having that extra person in the
delivery room who already knows them,

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who they have built trust,

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who knows the system,

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who will help them advocate for them
if they need it,

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and someone who probably knows
the culture, the language, and so ...

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we're kind of like that bridge

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between the health system and them.

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ASHLEY: We're going to start
with a deep, cleansing breath.

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So, that's in through your nose ...

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out through your mouth.

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As your doula, I am here to support you
in the birth that you desire.

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So, tell me a bit about,
what kind of birth are you planning?

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How do you see it going?

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ALEXANDRIA: I definitely see it
without an epidural,

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without any interventions

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as far as like induction,
Pitocin or anything else.

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-Okay.
-I definitely want a VBAC,

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because my first baby was a C-section.

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VBAC
A VAGINAL BIRTH AFTER CESAREAN

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So that's something I definitely want,
I want to experience ...

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I feel like, the birth that
I was robbed of from my first birth.

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Okay, so it sounds like your experience
the first time around

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is guiding you
in doing something different ...

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-Exactly.
-...this time.

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Yes. My last birth, I was induced
when I didn't have to be induced,

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because I walked into the hospital
already in labor,

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contractions already
three minutes apart.

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The doctor decided to still give me
Pitocin and Cervidil.

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I did not respond well
to either one of those things,

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and he did not either.

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His heart rate dropped,

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and that's what led
to the emergency C-section.

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And he ended up staying in the ICU
for about three to four days,

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so I wasn't able to do that first, like,
skin-to-skin, first breastfeeding.

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It was really traumatic.

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It sounds like it, and I'm hearing that
it sounds like things went very fast.

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-Yes.
-It sounds like there were times where

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things were given to you and you weren't
sure as to why you were receiving them.

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And I didn't know to ask questions.

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It sounds like oftentimes you felt like
there was no space to ask questions.

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Yes. I was just following
what the doctor said,

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and whatever the doctor said,
that's what I was supposed to do,

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instead of just advocating for myself.

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Absolutely, because you are
part of the team.

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-Exactly.
-Doctor says this is what we should do.

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-There is no harm in asking, "Why?"
-Exactly.

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"How?
What are the alternatives?"

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Always ask,

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so that you are an active part
of the decision-making.

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And I think I know better now,
second time around.

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Most doctors are happy to tell you.

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-You just have to ask.
-Exactly.

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THERE ARE THINGS YOU CAN DO

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TO HELP INCREASE THE CHANCE
OF A VAGINAL BIRTH.

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TIKVAH: Your body is awesome.
It's amazing.

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You'll be surprised how amazing
your body is, let's try to use it.

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Let's do breathing techniques,
the walking.

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I need you to get up
and let that gravity go

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because it's gravity that really helps
and puts the pressure on the cervix.

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CHRISSIE: One of my clients, when she
was in labor, they had to induce her,

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but the baby wasn't
always positioned correctly.

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So, her OB had told her, like,

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"Okay, we're just trying to help you
get your body right,

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but if the contractions are coming
really strong and consistent

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but you're not dilating
or the baby's not dropping,

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we might have to give you a C-section."

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I was thinking, "Oh my God,
all she got to do is re ...

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Let's try to reposition her
and do some different things."

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And thank God she did,
we prayed over her.

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TAYO: That's the step right there.

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CHRISSIE: Things just changed.

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KARIE: She was receptive to your moving,

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and your role was vital in making sure
that she had a vaginal delivery.

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EMILY: I really love
that doulas help reduce

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the cesarean section rate,
we've got lots of data to support that.

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Sometimes C-sections are the best tool
we have and absolutely necessary,

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but we want to make sure we're only
doing it when we really need it

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because there are some potential risks
with cesarean.

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It's a more dangerous procedure for mom,

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certainly than a vaginal delivery.

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Then, particularly for women
that want to have more than one baby,

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it increases the odds
that they might need a second cesarean.

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ASHLEY: If we were to end up
with another C-section,

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how would you feel about that?

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-Um, it would be disappointing at first.
-Mmm.

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But I want myself to be safe
and I want my baby to be safe as well,

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so if it ends up being that way,
that's how it's going to have to be.

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ASHLEY: I hear what you're saying,
disappointed, that's a valid feeling.

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Babies are born
in lots of different ways.

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And regardless of our best laid plans,

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this baby will come
the way it needed to come.

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ALEX: Yes.

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ASHLEY: So, if we made
informed decisions,

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if we were an active part of this team,

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if you felt confident
and supported the entire time,

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we shouldn't feel
too disappointed in that, right?

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-We had the birth that needed to happen.
-ALEX: Yeah.

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ASHLEY: And we tried our best.

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Another C-section is not a failure.
It's just a deviation from our plan.

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ALEX: Exactly.

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FOR MORE RESOURCES
ON C-SECTION AND VAGINAL BIRTH,

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