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The Caesarean

The Caesarean
by Michel Odent
Free Association Books, 2004

reviewed by Sara Dodder Furr
Lincoln NE USA
From: LEAVEN, Vol. 41 No. 2, April-May 2005, pp. 40-41.

One of the 10 concept statements in the La Leche League philosophical framework is "Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start." Alert and active participation is clearly easier during a vaginal delivery versus a cesarean delivery. Spontaneous labor, followed by a vaginal delivery with no medications administered to the mother, is usually identified as the ideal way for a mother to be actively involved in the birth of her child. A baby born this way is primed to have breastfeeding go well. The primary cesarean rate rose six percent between 2002 and 2003, while the rate of vaginal birth after a previous cesarean (VBAC) dropped by 16 percent. What do these statistics mean to us as we support breastfeeding mothers?

In The Caesarean, Michel Odent writes:

The primary objective should not be to reduce the rates of caesareans: it would be dangerous, if not preceded by a first step. This first step should be an attempt to promote a better understanding of birth physiology and particularly a better understanding of the basic needs of women in labor. In hospitals where the watchword is to reduce the rates of caesareans, the first effect is usually an increased number of difficult births by the vaginal route and of dangerous last-minute emergency caesareans. This is exactly what we should avoid in the age of the safe caesarean. I have had many recent reports of deliveries during which the obstetrical team tried "everything" in order to avoid a caesarean: drip of synthetic oxytocin, epidural anesthesia, and, finally, either a forceps delivery with episiotomy or even a caesarean after trying the use of forceps. Forceps have their place in museums. The last time I used forceps was in February 1965.

During the time that I was reading Odent's book, I found some handwritten notes from my mother who died more than 20 years ago. According to her notes, my maternal grandmother delivered her first child, a stillborn baby, on August 4, 1922. Seven years later, on August 4, 1929, my mother was born by cesarean delivery. It was perhaps meant to be that I discovered these notes while I was reading Odent's book. I now know my grandmother always grieved the death of her first child, and believed he would have lived if he had been delivered by cesarean. Learning this helped give some perspective to my own situation: I am the mother of three children, all born by cesarean. My three birth experiences differ from one another and from my own ideal of what I had hoped for my births to be like. Yet, I am grateful that this lifesaving procedure was available to my babies and me.

According to Odent, when a mother has a cesarean delivery, more assistance with lactation may be required, while in general it may be best to intervene in lactation as little as possible when the mother has delivered vaginally. Odent notes that many mothers successfully breastfeed after a cesarean. However, he notes that, "Non-labour caesareans seem to be associated with more breastfeeding difficulties." In his book, Odent details the physiological changes that occur during a normal birth. These changes are totally disrupted during something as extreme as a non-laboring cesarean, and it is this disruption of the physiological norm that impacts lactation, not the surgical procedure itself.

This book is a great companion piece to the Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum by Mary Kroeger with Linda J. Smith. Both books note that it is not the type of delivery per se that affects breastfeeding success. What does impact the success of breastfeeding is the multiple medical procedures and hospital practices associated with cesarean delivery. The greatest concern is the possibility of extensive early separation of mother and baby. This separation makes it difficult for a mother to immediately get to know her baby and respond to the baby's breastfeeding cues. In addition, some hospitals may routinely supplement babies separated from their mothers after a surgical birth in an effort to provide the mother with rest. Both the separation and supplementation work together to derail the success of breastfeeding. In my own case, I was fortunate to be able to arrange to have someone stay with me continuously, resulting in very little separation from my babies. Perhaps because of this, early breastfeeding got off to a great start with my second and third babies.

Odent's book explores what happens physiologically during birth and how the physiological process differs between a vaginal and cesarean delivery. One message, which is repeated again and again, is the importance of spontaneous labor, how this prepares the body for the delivery of the baby and makes it easier for breastfeeding and bonding with the baby to get off to the best start. Odent believes that the effects of birth are apparent throughout our lives. He writes:

Today, for the first time in the history of humankind, there are many ways to be born. Within the only framework of caesarean births, we must distinguish non-labour C-sections from in-labour C-sections and emergency C-sections. Whatever the final route, we must also distinguish induced labour from spontaneous labour. Among the vaginal births, some are drugless while many others combine in different ways epidural anesthesia and a drip of synthetic oxytocin. Is humanity evolving towards an unprecedented diversity of "native cultures"?

This book explains the role of a cesarean delivery, how cesarean deliveries are performed, when they are medically necessary, and how to minimize the possible negative impact on the bonding relationship of mother and baby and breastfeeding. As he has in other books, Odent discusses the important role of oxytocin in maternal/baby bonding and the impact on the initiation of breastfeeding. Having a cesarean delivery does not need to result in a failed breastfeeding experience. Cesarean deliveries can be life-saving for the baby and/or mother. Cesarean deliveries can be life-saving for the baby and/or mother. Odent makes it clear that elective cesareans — those performed for convenience only — carry risks for possible negative ramifications with bonding and breastfeeding. When mothers, obstetricians, and midwives weigh the risks and benefits associated with different types of birth in order to make a decision, the ease with which the mother will be able to bond and breastfeed should be considered.

Sara Dodder Furr has been a Leader in Lincoln, Nebraska, USA since 1999. She and her husband have three children. Sara is the Area Professional Liaison for LLL of Nebraska.

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