Understanding The Cesarean Risks (Then Decide...)
Cesarean births account for around a quarter of all deliveries today; that's about double the rate of surgically assisted births thirty years ago. In some US hospitals c-section rates are as high as 50%!
So why the rapid increase?
Interestingly, back in the 1980s, cesarean births were prevalent among the lower classes and in deprived areas, yet today, we live in a "too posh to push" nation where elective surgeries are common among the rich and famous. And why? Well, labor, by definition, is hard work and unpredictable work too!
Cesarean sections are major surgical procedures and they carry the associated risks of such surgeries. Of course, emergency and planned c-sections for medical purposes are without a doubt safer for both Mom and baby than a vaginal delivery, but if you're considering an elective c-section birth it's important to understand the cesarean risks when compared to a natural vaginal delivery.
In this article, you can read about the main risks for baby and mom associated with c-sections. We don't mean to scare you, but believe strongly that knowing is always better than guessing...
Cesarean Risks For Baby And Mom
Risks for BabyResearch seems to indicate a definite link between respiratory disorders and cesarean births, with studies finding moderate increases in asthma and allergies in c-section babies. One study found the risk of respiratory distress to be a whopping five times greater in newborns who had been born by caesarean section, leading to life-threatening conditions. Sadly, a further study concluded that 'those delivered by elective caesarean section around term have an increased risk of overall and serious respiratory morbidity'.
The same findings were not found in babies born via emergency c-section, leading to the suggestion that it's all down to timing. Emergency surgeries are usually performed after a problem arises during a natural labor, when the baby is ready to be born. Elective surgeries are usually performed between 37 and 39 weeks gestation. With a 'normal' pregnancy generally progressing to around 40 weeks, it's very possible that some infants do not have lungs that are mature enough to cope with unassisted breathing prematurely.
Risks for MomWe all know that there are risks with any surgery, whether that be a quick and simple 'lunchtime' procedure, cosmetic surgery, or a major surgical procedure. Anything that involves anaesthesia is always going to carry risks. Fortunately, the risks are quite small (they're often increased with existing medical conditions such as high blood pressure and obesity), but there are some additional risks associated with caesarean sections in particular that should be taken into account when considering what type of birth you'd like.
Firstly, after a caesarean you are going to be left with a huge abdominal scar. There's no sugar coating that fact. To extract a 7lb baby from your uterus, a big incision needs to be made - this isn't keyhole surgery! As with any scarring, there's a risk of wound infection. Wound infection is reported in 2-16% of women following caesarean births, with 7.8% of women having significant infections requiring extended hospital stays and increasing the risk of postpartum morbidity.
During the surgery, due to the proximity of the bladder to the uterus (babies have a tendency to squash all your internals together as they grow) there is a significant risk of bladder injury, and studies have found that this risk increases with each subsequent caesarean delivery. Bladder injury can mean further, intrusive surgery may be required, it may be very difficult or painful to urinate, a catheter might be required and the risk of ongoing bladder infections increases.
With all associated risks added up, the risk of maternal morbidity following a caesarean is greater than following a natural vaginal delivery. One study reported figures as a 2.73% risk vs a 0.9% risk respectively. The difference isn't earth shattering, but it's certainly worth considering these numbers.
Future PregnanciesAlthough more babies may be the last thing on your mind, if considering a caesarean delivery it's important to think about how any future pregnancies may be affected (almost all new Moms have uttered the phrase 'never again' and then gone on to have many more children!).
Studies have found increases in the risk of placenta previa (where the placenta attaches to the lower half of the uterus and partially or fully covers the opening of the cervix) and placental abruption (where the placenta detaches itself from the uterus during the pregnancy).
The risk of abruption during a second pregnancy in women who had a previous caesarean birth is thought to be around 0.95%, and 0.74% for those with a previous vaginal delivery. Two caesarean births brings this figure up to 30% for third pregnancies.
A further study has found that unexplained stillbirths at term are twice as likely if the mother has had a previous caesarean birth as for women with previous vaginal deliveries.
BondingMother-baby bonding following birth is extremely important, and it's why skin-to-skin contact immediately following a vaginal birth is recommended. This skin-to-skin time doesn't happen as quickly following a cesarean birth as the surgery needs to continue, so can this method of delivery affect the all important bonding process?
Research reports that mothers who had a caesarean birth took longer to bond with their newborns than those who had a vaginal birth, and the differences persisted for several months after the birth. One study concluded that caesarean mothers have much less contact with their infants in the first 24 hour period, as the effects of the anaesthesia and fresh scarring make it difficult for new Moms to meet all the needs of their newborn such as soothing and changing.
A further study found that 78% of caesarean mothers report very high levels of pain in the first 24 hours following birth, something that has a negative impact on infant care and breastfeeding. Breastfeeding is one of the main bonding techniques for Mom and baby and a struggle to do this could lead to feelings of inadequacy and possibly slight resentment. Don't forget that emotions run high during this major life event.
Should I Consider An Elective Caesarean Delivery?If a caesarean section is required for medical or emergency purposes, there is absolutely no question that the safest option for both you and your baby is to undergo the procedure. Even if you've had your mind set on a natural birth, don't forget that Moms who have vaginal deliveries don't get a medal and their names aren't added to the 'natural delivery hall of fame'. Once you've got your baby, parenthood is equal, it doesn't matter how you did it.
If, on the other hand, you're considering an elective surgery, that's fine as long as it's what you want - and in my view - you are aware of the cesarean risks. Although bonding may take longer (who knows if that's actually true or not - there are plenty of Moms who delivered naturally who didn't feel an instant rush of love for that screaming, needy little person who just tore them from back to front!), research doesn't tend to find any lasting effects.
It is important to weigh up the pros and cons of the surgery and decide if it's right for you. Different strokes for different folks.
As a start, have a look at the two videos below. One is showing a normal (not emergency) elected c-section. Everything went well and the mom explains her choices and feeling about it.
The second is from "The business of being born", the information series produced to take a deep look at the whole birthing business of the US. Definitely worth spending a few minutes on!
If you want to get this video, you'll find it on Amazon here.
Books And DVDs On ChildbirthThere are many excellent books and courses to learn about giving birth. If you are still not sure whether to go for a planned c-section or vaginal birth, one of my favorite natural childbirth resources is the online course by Catherine Beier, who is a strong proponent of natural childbirth. You can review her course here.
In addition, the following books and DVDs are highly recommended:
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