While most babies these days are still delivered vaginally, a significant number — around 30% — are delivered via Caesarean section, or c-section. This is a surgical delivery where babies are removed through an incision in the mother’s abdomen. The c-section rate has been on the rise for a long time and is now often performed as a “scheduled c-section,” meaning planned and not an emergency, both for mothers who have had previous sections and mothers who simply prefer to have one. But they’re major surgery and shouldn’t be taken lightly.
Make no mistake: when used judiciously, c-sections can save lives. The World Health Organization aims for a c-section rate at or below 10%; some studies suggest around 4% is ideal. There are mothers who simply need a c-section. This may include mothers who have misshapen pelvises, whose babies are transverse, who are having multiples, or who have other specific risk factors that make c-sections the safer way to deliver their babies.
Planned c-sections, scheduled for whatever reason (misshapen pelvis, for example), are usually done with a “low transverse” incision, or a small cut just above a woman’s pubic bone. The baby is removed, as is the placenta, and the woman is sewed up. There is a low rate of uterine rupture and other problems with this type of incision, as the uterus is thinnest here. For the most part, these women will have an epidural, so that they can remain awake during the surgery. Women who have this type of c-section can usually try for a VBAC (vaginal birth after caesarean) if they are good candidates otherwise.
Emergency c-sections may be performed with a low-transverse incision if possible; however, some women need to be cut from their belly buttons down to their pubic bones. This allows the doctors the fastest way to get the baby out. Very heavy women are more likely to need this type of incision. Doctors can deliver a baby in less than a minute via c-section if something is wrong. Some of these women may have general anesthesia if there is not enough time to administer an epidural. It is incredible to have the sort of technology that can save a mother and/or baby’s life when necessary.
What’s the Problem?
We are way over that “optimal” 10% rate. The country’s average is around 30%, and various hospitals can vary from 10 – 80% c-sections in first-time moms! A lot of c-sections are performed for “failure to progress” (after mothers are induced too early, then strapped down to a bed, and not given much time to progress) or for the convenience of the doctor. Women are not often adequately informed of the risks of a c-section as an elective procedure, either.
Clearly, c-sections are overused. The following increases a woman’s chance of having a (probably unnecessary) c-section:
- Being induced prior to 41 weeks (especially prior to 39)
- Being given a “timeline” for progress
- Having Pitocin, an epidural, and other interventions (“cascade” of interventions)
- Laboring/pushing flat on her back
When interviewing doctors initially, it is important to ask what that doctor’s c-section rate is, and what his/her attitude towards c-sections is. A doctor who has a high c-section rate and a cavalier attitude towards them is probably not the type of doctor you want to see.
Risks of a C-Section
What are the risks of having a c-section? Let’s take a look at a few:
- Negative/allergic reaction to anesthesia
- Uterine rupture in future births
- Excessive bleeding
- Infection at the incision site
- Cutting the baby (possibly badly)
- Long/difficult recovery
- Blood clots in the legs or lungs
- Maternal death (rare)
- Increased risk of NICU stay for baby
- Breathing problems for baby (due to prematurity and/or fluid remaining in lungs)
- Placenta previa (where the placenta blocks the cervix) or accreta (where it grows too deeply into the uterine wall) in subsequent pregnancies
As you can see, a c-section is not without risks. Before a c-section is performed, especially in a non-emergency situation, it is crucial to take into account the risks vs. benefits to see if a c-section is really the best option.
Avoiding a C-Section
Unless you are in a particular high-risk category who would be better served by having a c-section, there are things that you can do to try to avoid one. These include:
- Seek care from a doctor or midwife with a low c-section rate
- Avoid induction, unless medically necessary
- Arrive at the hospital only once labor is well-established
- Refuse an epidural (so that you can continue to move around)
- Ask to try different positions for labor/pushing
- Hire a doula to help you
These are all ways to help your labor along naturally, when your baby is ready to come, which decrease your chances of having a c-section.
It’s important to remember that it is not always possible to avoid c-sections. There are cases where they are necessary and they do save lives. However, it is good to be informed of the risks so that if you are in a non-emergency situation, you can choose carefully.