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   Cesarean Section vs. Natural Birth: Experiences of Expectant Mothers 

In the suburban county of Rockland, New York, there are only two hospitals: Montefiore Nyack Hospital and the larger Good Samaritan Hospital. In the latest available database figures, Montefiore Nyack Hospital delivered more babies by cesarean section than Good Samaritan Hospital, in 2016.

The New York State Health Department reported 30 percent of C-sections taking place at Montefiore Nyack Hospital, with less than 20 percent performed at Good Samaritan Hospital. In terms of vaginal deliveries, 70 percent occurred at Montefiore Nyack and 80 percent at Good Samaritan.

The experience of a C-section delivery varies from woman to woman. Sally Colistra, of Stony Point, New York, gave birth to her daughter at Montefiore Nyack Hospital. “Before I got pregnant, I had fibrous tumors removed from my uterus and they had to make an incision. They were afraid that if I went and gave natural childbirth that incision would burst during my pregnancy.”

Colistra added, “It wasn’t all that physically painful, but emotionally, it was huge on me because I was just worried that one little flip that would be it, and it would disrupt the whole pregnancy and they could harm my daughter inside of me.”

According to Colistra’s doctor, in order to decrease the likelihood of a birth defect, a C-section had to be performed. In Colistra’s case, this type of birth increased the chances of her having a healthy delivery and a healthy baby. According to the U.S. Centers for Disease Control (CDC), every 4 ½ minutes, a baby is born with a birth defect in the United States. That means nearly 120,000 babies are affected by birth defects each year.

In addition to fibrous tumors, Colistra had beaten cancer. “I had breast cancer five years ago, before I got pregnant with my daughter, and there are no studies out for chemo on what they can do on a pregnancy. Any mother can have a C-section and it is not something that should be underestimated.

What is the C-section process like?

New York State’s Maternity Information Law mandates that every medical facility issues information about its childbirth practices and procedures. Registered nurse, Cindy Nguyen who graduated from Stony Brook School of Nursing says, “After they cut open the layers and they take out the baby they move the babies into the isolette where the pediatricians assess the baby and listen to the heart sounds and lungs to make sure the baby is good.” Nguyen goes on to say, “Then they reunite, sew the mom up and then they take the baby out.”

Ciara LeGrand, also a registered nurse explains what the C-section process is like for expectant mothers. “With a C- section it’s right then and there, the mother is awake they don’t put you to sleep. They give you a mild Anesthesia but you can still feel it [the operation] a bit.” LeGrand goes on to say, “For the Epidural [Anesthesia], the mother has to be [seated] up and it has to go in the spine and if there are any sudden jerking movements she can become paralyzed …it’s such a careful procedure.” Every pregnancy is different and with that, each expectant mother’s feelings towards baby delivering varies as well. “Generally when mothers come in you don’t know what to expect because they can come in and their water has already broke, they can come in happy, upset or scared, there are so many emotions in the maturity ward”, said LeGrand. An expectant mother is typically not given a choice about having a C-section, before a baby being delivered. Doctors say careful consideration regarding the health of the mother and fetus is taken into account, and comprehensive precautions are implemented.

According to the New York State Department of Health, different kinds of Anesthesia are given to an expectant mother before going into delivery. “For Spinal Anesthesia, a drug is injected into the lower spinal area to numb the vaginal region. For Epidural Anesthesia, a drug is given through a fine tube inserted in the mother’s lower back to numb the vaginal area and lower abdomen. For Paracervical Anesthesia, a drug is injected into the cervix (opening of the womb) to relieve the pain of labor. In a Pudendal block, a drug is injected into the vaginal wall shortly before delivery to relieve pain between the vagina and anus in case of an episiotomy or tear during delivery.” This kind of Anesthesia changes depending on the kind of birth a mother is having and if she having any complications during her pregnancy.

Nakeya White, of Spring Valley, was faced with issues even before her baby was born, which led to her C-section. “During my pregnancy, I failed the glucose test and it came back that I had pregnancy diabetes.”

For White, the C-section procedure was a very tough experience. “They gave you a needle in your back to numb you from the waist down and they tell you that you can’t move because you’ll paralyze your body. Everything was just sad for me, so I was crying the entire time.”

White added, “They give you literally like 5 minutes to get ready, so they have a whole bunch of nurses coming in wiping you down, dressing you, and preparing you to go into the room. Then they sent me downstairs for an ultrasound just to check on the baby and she was saying that Carter wasn’t moving…so then we went back upstairs. There wasn’t a heartbeat and the baby wasn’t breathing, so they had to do an emergency C-section.”

Pediatrician, Dr. Gomathi Adhiyaman, said, “There is no different care unless the cesarean section babies have issues like meconium aspiration or TTN (Transient Tachypnea Of The Newborn)…Cesarean section babies have fluid in their lungs, cesarean section babies may have fluid in their ears but not all of them will have the same thing.” Colistra said that in order to check if the child’s lungs are fully developed before delivering, the mother must receive a shot in her womb. She added, “The day before, they have to make sure the baby’s lungs are developed so they have to do the amnio, and they have to stick it in your belly.” According to Kids Health, TTN is more common in babies whose mothers test positive for asthma or diabetes.

Meconium aspiration occurs when a baby is stressed and suffers through shortness of breath during the pregnancy. This may also occur after taking their first breath of oxygen. Jessica Middleton, of New City, underwent a C-section for the birth of her son. She said, “The doctors told me the baby is stressed, which is why he wasn’t breathing, and I had to do a C-section.”

Middleton believes it is important to have a certain mindset going into a delivery. “If you are having a baby, you know you’re either pushing or getting cut open, so you kind of go in knowing this is going to happen, so you better be a big girl. I was aware of what it would be like and what I would be going through based on the things I read and the things I have seen on YouTube, but the experience was crazy and I don’t ever want to do it again. Every mother’s experience is different when it comes to delivering a baby,” said Middleton.

She added, “Some women have a natural birth at home, so what makes you think you can’t do it in a hospital? The severity of giving birth given the circumstances of it; giving birth can potentially lead to the death of the child or the mother. A C-section is one of the most dangerous medical operations; there are two lives in jeopardy. You are lying there. You don’t know what’s going on. You don’t know if the doctor messed something up. It’s a big surgery.”

 Whether it is through natural birth or C-section the doctor must deliver the baby to protect the mother’s life and the infant’s life. Delivering births through C-section is often the secondary option. C-sections are only completed if they are needed. Dr. Olufunmilayo Odunuga whose is a New York State OBGYN says, “If the mother is unable or if the baby is showing signs of composure that is unusual, usually that’s what drives us [doctors] to do C- sections or to try and deliver quickly.” Dr. Odunuga says, “In New York State there’s quality controlled so that doctor’s goals should try to attain numbers that are lower than the number the [American College of Obstetricians and Gynecologists] recommend. There are certain guidelines that we have to meet.” The doctors must follow proper guidelines to ensure that constant safety is met.  

“The world is not perfect where we can meet those goals at all times given the health of the patient at all times.” Every mother cannot deliver birth naturally whether it is due to her health or the infants. Often, expectant mothers are not aware that they will have a C-section until the day of their delivery. Dr. Odunuga says, “It depends there are so many medical conditions that determine early if you need a C- section but there are a lot of conditions that you would not know about until you go into labor.”

It is not uncommon for a mother to go into the delivery room and receive a C-section without completely understanding the surgery. Often times before the operation begins physicians are unable to fully explain what a C-section is to the expectant mother. “There are times when the baby is crashing that you don’t really have all the time to explain it [C-section] thoroughly to the patient”, said Dr. Odunuga.

Alice Anderson, of Spring Valley, was informed by her physician that her weight was an issue. Her doctor told her that, due to her extreme weight gain, she would need to deliver her baby via C-section. Anderson said, “I was not surprised because he [doctor] had already told me that the size that I’m at, she [daughter] might be a C-section. I never thought about it because I don’t get scared easily.”

The New York State Health Department provides guidelines to expectant mothers to help them prepare for a healthy delivery. Each hospital or birthing center provides its own set of guidelines on how to have a baby and take care of him or her. The state recommends that mothers speak with their own health care provider about preparation for delivery and the choice of a hospital.

Rockland County, New York hospitals

According to Statista.com  the average cost of a C-section in the state of New York, without health insurance, is $22,059.22. For those who meet the criteria for Medicaid, New York State Medicaid provides coverage for complete pregnancy care. The services include the following: 

• Full health care at least two months after delivery
• Health care for a baby for a minimum of one year after birth
• Hospital treatment during pregnancy and labor
• Constant pregnancy medical check-ups, lab work, and access to specialists

Dr. Adhiyaman said that mothers should not be concerned about having a C-section. “There is no care which is different in me taking care of vaginal and C-section babies unless they show symptoms; this is nothing to worry about.” Having said that, medical professionals say it is important for expectant mothers to know that cesarean deliveries carry a risk for the mother and child.

Expectant mothers are expected to address all of their concerns about their health and the infants with each of their physicians during their pregnancy. “Ask questions long before they get into the labor room these are questions they can be asking at their prenatal visit.” Dr. Odunuga goes on to say, “All of that will reduce anxiety and make patients understand what to expect and make that disappointment decrease theirs always reasons why we [doctors] do certain things.”

According to the CDC, the number of women giving birth via cesarean section has been steadily increasing over the past 20 years, with about one out of every three babies born via C-section.