The following article's primary data and analysis source is the 2004 Maternity Center Association booklet, "What Every Pregnant Woman Needs to Know About Cesarean Section." I encourage expectant mothers and women's health care providers to access the booklet at: http://www.maternitywise.org/pdfs/cesareanbooklet.pdf.


Did You Know?

• The rate of births by cesarean section has been rapidly increasing in recent years. In 1970, c-sections accounted for five percent of American births, while now they account for 28 percent.

• Currently, 3 in 10 American women give birth by cesarean, a major abdominal surgery.

• C-section has become the most common surgical procedure performed on women of childbearing age.

• Elective, "by request" cesareans are becoming more common every year. One study by a publicly-traded healthcare ratings company even claims to have found a 36 percent increase in elective cesareans between 2001 and 2003.

• Cesarean section, a major abdominal surgery, can be a life-saver for both mother and baby in a small number of cases. But for most women and babies at the end of pregnancy, the risks of surgical birth outweigh benefits.

• Thanks to vast research and data collection of recent years, we've learned that the perception of c-section as "totally safe" or even preferable to vaginal delivery is unfounded.

• Here's what the body of research tells us: Compared with vaginal birth, cesarean section can increase a woman’s risk for a number of problems, including:

Severe bleeding
Blood clots
Bowel obstruction
Severe infection
Severe post-operative pain
Delay in release from the hospital
Rehospitalization
Mental health and emotional difficulties, including PPD (postpartum depression)
Lowered future fertility
Future ectopic pregnancies that develop outside the uterus or within the scar
Pre-term or low birthweight babies in future pregnancies
Physical abnormality or damage to the brain or spinal cord of future babies
Increased chance of fetal or newborn death of future babies.


• C-sections are also associated with increased risks for newborns, including:

Difficulty breastfeeding and/or bonding, due to decreased early contact with the recuperating mother
Breathing problems around the time of birth
Asthma in childhood and adulthood
Cuts (usually minor) from the cesarean surgery itself.

• A planned cesarean offers some advantages over an unplanned c-section, which happens after labor is already in progress. Unplanned c-sections tend to impact the delivering mother heavily in terms of her emotional health. However, c-section under any circumstance does come with the risks of a major surgery. Any c-section will cause a uterine scar and impacts your future pregnancies equally.

• It’s important to know that an assisted vaginal delivery – that is, one involving forceps or vacuum extraction to get the baby out – also carries more risk than an unassisted vaginal birth. A woman with an assisted vaginal delivery is more likely to have bowel problems, hemorrhoids, pain with intercourse, emotional distress during the postpartum period, and a baby at increased risk of injuries to the arm, hand, face, and brain.

• Though there clearly are medical situations in which either a cesarean section or an assisted vaginal birth is appropriate – even lifesaving – the safest, healthiest birth for the majority of women is still the good, old-fashioned unassisted vaginal delivery. Nature is no idiot.

• So why all the c-sections these days? There answer is at least fourfold – medical, financial, legal, social. Ob/gyns feel pressure to practice medicine “defensively,” and tend to think that opting for a c-section protects them from litigation. Also to protect themselves legally and financially, many doctors will not perform a VBAC (vaginal birth after cesearean), even when the woman requests one and there’s no clear medical reason why it shouldn’t be attempted. (The latest research -- and a statement from the NIH -- tells us that for most women, VBAC is safe and desirable.) Many doctors don’t try less invasive procedures, like turning a breech baby or giving a laboring woman more time, using c-section as more of a first choice than a last resort. Some doctors are unwilling to allow a woman with twins or a breech baby to attempt a vaginal birth, period. The “medical model” of birth in our culture, which understands ALL births as medical events requiring significant intervention, normalizes c-sections to a large degree.

• What can you do if you really want a good shot at an unassisted vaginal birth? Choose your doctor or midwife carefully. Ask about their policies and common practices. Consider multiple types of birth settings, and ask about their rates of epidurals, artificial induction of labor, cutting episiotomies, using synthetic hormones like oxytocin, and use of non-emergency electronic fetal monitors and IVs. Ask if laboring women are allowed to get up and move around, eating and drinking when they want to during labor. (Research shows that women allowed to be upright, moving, and well-nourished have much lower rates of c-section.) If you don’t find a hospital you feel good about, consider a freestanding birth center or even an attended home birth, with the hospital as a backup in case complications arise. Also, consider the use of a doula, a woman trained to provide labor support, “mothering the mother.” Research shows that women with doulas have lower rates of birth complications. Since avoiding an epidural can increase your chance for an unassisted vaginal birth, take a good class in pain management during labor. There are many techniques – like tubs, showers, inflatable birth balls, massage – that can help. You can also write a birth statement of your desires for the delivery. Keeping in mind that in an emergency situation the birth statement may fly out the window, it can really help you clarify your values and what you most want for your baby’s delivery. It can make communicating with your partner and your doctor or midwife much easier and clearer when you’ve taken some private time to write down your goals and wishes.

• If you find yourself at the hospital with a doctor proposing a cesarean, and it’s not an emergency situation, ask him or her to go through ALL of your options and the risks/benefits of each. In a non-emergency, do not be afraid to ask for more time to consider the options and discuss with your partner.

• And if all else fails and you end up with a cesarean or an assisted birth for any reason, do not allow yourself to think of the birth – or your body – as a “failure.” This simply isn’t the case! Remember that occasionally medical help during birth is a necessity and a blessing. Celebrate your new baby and his or her good health, and be kind to yourself, body and soul. It will speed your recovery and help you get on with enjoying your newborn!