A Guide to Understanding the Cesarean Section

December 10, 2008

By Nouf Bazaz

A cesarean section (known as a C-section) is a major abdominal surgery and should not be taken lightly. In cases where it is absolutely necessary, it can be a lifesaving technique. However, in the United States, one out of every three babies is born through a C-section despite the WHO recommendations that the rate should never be above 10-15%. A C-section not only interferes with the natural childbirth process but can also pose great risks to both mother and child.

C- sections are performed for four main reasons: repeat cesarean, non-progressive labor or dystocia, breech presentation and distress. However, a medical study found that the rate of cesareans in low-risk women is steadily increasing across every demographic. [1] This indicates that the criteria for what warrants a C-section has changed. For example, more careful diagnosis and better management of dystocia could halve the C-section rate. In one study when the labor was termed “non-progressive” and a C-section was performed, 77% of those women were able to have a vaginal birth for a subsequent birth. One third of the women delivered babies that were larger than in the first instance that had apparently warranted a C-section. The epidural may also be another cause of cesareans associated with dystocia.

Over the years, a culture has evolved that is much more lax in regards to the C-section and women may not understand the risks involved. Some women even elect to have a cesarean because it is considered more convenient and painless. In some cases, women who have diabetes are even led to believe that they need a C-section despite the fact that diabetes is not the only factor that should be considered. [2] Healthcare providers are also more inclined to do a C-section because of the risks of malpractice lawsuits associated with problems during vaginal births. Women and healthcare providers alike are then cornered into a maternal health system that greatly endangers newborns. The maternal mortality rate is two to four times higher with a C-section than with a vaginal birth. There is also a great risk of infections, hemorrhage, transfusion, injury to other organs and anesthesia complication. After the C-section, early interaction with the newborn can be delayed and there is a six to eight week recovery period afterwards. In 1987 when the rate of C-section was similar to today, it was found that half of the C-sections conducted were unnecessary and resulted in 25,000 serious infections, 1.1 million extra hospital days and a cost of over $1 billion.

Vaginal Birth After Cesarean (VBAC) is another highly contentious matter. In the past, vaginal birth was not possible after a C-section under any circumstances lest the scar from the C-section may tear. However, today over 60-80 percent of women have a successful VBAC. In fact, a VBAC is may be a safer option than a subsequent C-section. Depending on the incision of the original C-section, you may be a candidate for a VBAC.

• Classical incision/T-shaped, inverted T-shaped or J-shaped: not possible
  
• Low transverse incision/ low vertical incision: may be possible
  

Be sure to ask your health care provider to disclose all of the details of your prior C-section. Furthermore, be sure to consider all of the possible risks and benefits. A VBAC has a shorter recovery time and allows you to participate more in the birthing process. Immediately following delivery, you may be able to bond with your child and establish breastfeeding. A vaginal birth is also half the cost of a C-section. However, if an unplanned C-section needs to be administered in an emergency situation, the cost will be greater. Many hospitals in fact do not even allow for VBAC because they do not have the surgical staff on hand or want to incur the risk of such an emergency.

Although, a cesarean section is absolutely necessary in some cases, it is often administered in many low-risk patients. It is your responsibility to become informed of your options. If your doctor recommends a C-section, ask if it is absolutely necessary. Convenience is never an acceptable reason for a C-section as it could have severe repercussions for you and your children. It is your right to seek a second opinion from another medical professional if needed. Do not be intimidated and always remember that you are in complete control of your body. The birthing process should not be regarded merely as a medical procedure but as a natural process that should be celebrated. Choose the method that works best for you and your baby and cherish the experience.

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Resources:
Cesarean Fact Sheet: http://www.childbirth.org/section/CSFact.html
International Cesarean Awareness Network: http://www.ican-online.org/
VBAC- Mayo Clinic: http://www.mayoclinic.com/health/vbac/VB99999/PAGE=VB00001

[1] Sachs BP, Kobelin C, Castro MA, Frigoletto F. The risks of lowering the cesarean delivery rate. N Engl J Med 1999;340: 54-57.
[2] Moses R, Knights S, Lucas E, Moses M, Russell K, Coleman K, Davis W. Gestational Diabetes: Is a Higher Cesarean Rate Inevitable. Diabetes care 2000:23