C-Sections: What You Need To Know
When the Baby's in Trouble
Fetal distress is usually recognized by a markedly slowed or accelerated heart rate because the baby, like her mother, can become exhausted by prolonged labor. A fetus can also contract an infection in the womb, suffer the effects of maternal illness, or become oxygen-deprived as a result of problems with the placenta or umbilical cord. My daughter Eva was surgically delivered -- limp, blue, and awash in meconium, a greenish stool that an overstressed fetus can pass into the amniotic fluid. Watching from the side of my surgical drape, Gary saw it all and heard me cry out, "Is my baby okay?" once, twice, three times.
Though their silence was terrifying at the time, doctors tend to ignore such questions as they rivet their attention on the lifesaving tasks at hand. Sixty seconds after her birth, Eva's Apgar score was a dreadful one, on a scale of zero to ten. A cluster of neonatologists rushed her to intensive care, as Gary ran behind.
On day two, Eva rebounded. A nurse pushed a rocking chair into a storage closet outside the intensive-care unit, and there I held my daughter to my breast for the first time.
When Labor Doesn't Progress
Joy Alex, of Pittsburgh, had been laboring nearly 26 hours when she felt herself giving up: "Here I was, pushing with all my might, and this baby wasn't moving!" In medicalese, Alex was experiencing "failure to progress."
Progress through labor and delivery requires three things: strong contractions that effectively dilate the cervix to ten centimeters; a fetus that is able to descend successfully through the birth canal (called second-stage labor); and a pelvis roomy enough to permit that passage. When any of these are absent, progress can slow or stop.
At what point does such a delay mean a c-section? Although obstetricians have guidelines, various factors, including the mother's wishes, influence the final call. In general, though, doctors will perform the procedure when little dilation has occurred after 24 hours of labor, though some will wait longer if both mother and baby are doing well. Similarly, most doctors suggest it if second-stage labor lasts more than two hours.
Alex was well past these benchmarks before she was willing to even think about a cesarean. She'd tried all sorts of positions -- "on my knees, on my side, with my belly on a ball" -- but the baby still needed to make a quarter-turn to slip through the birth canal. The doctor on call believed he could deliver the baby with forceps following an episiotomy (a cut in the muscle between the vagina and the anus). If that didn't work, he would deliver the baby surgically.
Alex agreed to this plan; half an hour later, she was headed for the operating room, where her daughter, Elena Noelani Alex-Finley, was born. After the doctors closed her incisions, a nurse placed Elena on the gurney, by her mother's head, and wheeled mom and daughter out to greet the relatives who were waiting anxiously outside.