The myth of the emergency c-section

It seems like when you're talking about a c-section, it often comes down to a question of semantics. The word "emergency" gets thrown around an awful lot, and I can't help but wonder if there's any validity anymore to the "If I didn't have a cesarean, my baby and I would have died!" argument.

Nowadays it seems that everyone has had an "emergency" cesarean. Come to think of it, depending on who you ask, I've had two of them.

To some, it seems like if labor has started and it's obvious a vaginal delivery won't take place, it suddenly becomes an emergency. I read one comment on a birth forum about a woman asking what happens when you go into labor before a scheduled cesarean, and the response - from a labor and delivery nurse, no less - was, "Your scheduled cesarean becomes an emergency cesarean. No big deal." Aren't emergencies usually a big deal? And what about this is indicative of an emergency?

In my situation, I went into labor before a scheduled cesarean. I came to the hospital in plenty of time, and was 4 cm upon arrival. Even if they had left me sitting there for a few hours, I probably would have been just fine. Was this an emergency? Not really.

Even after my second cesarean, when a nervous soon-to-be-new dad asked me if it was an emergency after hearing the hairy details of the birth, I sort of shrugged. "Yeah, I suppose you could say it was emergent," with an air of hesitation. I was already fully dilated when I got there, but had no urge to push and no little feet were sticking out. Emergency? Probably not.

Nothing confirms my suspicions about the true nature of emergency cesareans more than this comment from My OB Said What?!?:

“It’s extremely urgent we do the cesarean now before your baby goes into stress and it becomes life-threatening. Let me just deliver the woman across the hall and then we can get things ready.”

Seriously? If you have that much time to wait, then it must not be an emergency. If this comment had come from anyone else (assuming that most contributors to MOBSW "get it" and see it for what it really is), I'd probably smile and nod and walk away muttering something. It seems like once you throw the word "emergency" in there, suddenly everything comes to a grinding halt and "your baby would have died had you not had that cesarean!" Are you sure about that?

I've heard countless comments like that from so many people and wonder what the real back story was. I wasn't there, obviously, but the minute they mention the words "induction" or "Pitocin," I cringe inside. They don't even realize their "emergency" was likely brought on by the actions of their physician, who either meant well or was deliberately putting them at greater risk for his or her own purposes. Putting on a sympathetic face and frowning while saying "You're going to need an emergency cesarean!" sounds better than, "I need to catch a plane and I need you to push out this baby." (Although some physicians no doubt don't bother to cloak it in concern and just tell it like it is.)

I read one such account from someone commenting on a blog post about a teenager who was in labor, and the doctor was pressuring her to consent to a cesarean. As the physician walked out, this person overheard her say, "Thank God she finally consented. Now I have just enough time to catch my flight." Unfortunately, because of this experience, this young mother will forever have the word "emergency" emblazoned on her mind and think her body failed, and it was the only way. Which is a lie.

It's hard, as a birth advocate, to hear these stories. I think for some, it's a mixture of several things: pride, ignorance or misinformation, and a blind trust in their physician. They do not want to admit that they believed their doctor would tell them everything and that he lied. They do not want to admit that perhaps they made a decision that could have turned out better had they only known more. Or they just had no idea that things could be different. Birth stories are something that are shared between women, even strangers, who otherwise have little if any connection to each other and yet are willing to talk about those intimate moments with a woman they don't even know. And thus not only is the birth of a child talked about, but the birth of a myth is, as well.

One mom I know told me that when she delivered her only child in the 1980s, she was induced. Her baby went into distress and she had a cesarean. Another mom had AROM with her first, which produced cord prolapse and an emergency cesarean. (She was, however, able to VBAC twice after that with the same doctor.) Still another talks about how a friend is going in for an "emergency" cesarean at 37 weeks because the baby is "small" (estimated at five pounds, three ounces by an ultrasound, which can be a pound off, either way). (What baby isn't small with three to five weeks to go?!) This mom tried to birth vaginally after being induced, but her doctor, from the looks of it, rushed her into a cesarean after she was dilated to 8 cm after only two hours with a posterior baby. Now she feels like a failure and that her body is "defective." How can you explain to someone that perhaps your "emergency cesarean" was an "iatrogenic emergency cesarean"? That sounds a bit clunkier and hard to pronounce, and still few are ready to listen when told their doctor might have been the initiator.

I posted these terrific articles recently about a hospital in Minnesota that has a very low c-section rate because they use midwives. They show a mom laboring in a tub, without pain medication, and also talk about midwives repositioning a mom in order to birth her baby vaginally. Yet, based on the comments from some people, they still don't get it. Another article - this time from England - talks about the "myth of too posh to push," and still others don't understand. Most are probably in denial that their doctor, the person they have trusted, could ever do something to hurt them or their babies. Many like to put the onus of elective cesarean on the mother and her choices, and to some extent, we can't discount that. But I can't stand the mentality that no doctor will ever do an unnecessary cesarean in the US, because that's obviously not true. If only we could better discern which ones were true emergencies versus those in which the doctor only said they were, for dramatic effect in encouraging you to make your decision faster (i.e. the "Catch my plane" cesarean mentioned above).

When looking at cesarean rates over the last few decades, they have increased steadily just within the last 20 years, in which time we've still had "modern" obstetrics to save us from ourselves in case of just such an emergency. Considering the rates are continuing to climb, what does that mean? That we're evolving into a species that suddenly can't give birth vaginally? That suddenly birth is much more dangerous than it used to be only two decades ago? I wonder, if people bother to look at the stats, if they even for a moment think about the absurdity of what they're saying. And can we quit blaming the mother for everything - from her "preference" to her weight and stature - and for once look at how her labor and delivery are managed by her doctor?

We use the term "emergency" so casually - paralleling the casual attitudes towards surgical birth in general - and water down its meaning until we don't even know what is normal and what isn't, or how to define a life-threatening situation. These attitudes, myths and misconceptions have totally changed not only our attitudes about what constitutes a real reason to have a cesarean, but clouded our view of birth as a whole.