Cesarean Sections

General Information

v The World Health Organization (WHO) states that, worldwide, c-sections should comprise a maximum of 8-15% of births.

v The US average for births ending in cesarean sections is 30%, though in some areas it is 35% or more. Some hospitals have reported cesarean rates in excess of 50%.

v The average reflects a 400% increase in less than 15 years. This increase in US c-sections has NOT led to an improvement in infant mortality or morbidity rates during this time.

v WHO states that 50% of the cesareans performed in the US are unnecessary.

v The largest percentage of most c-sections are performed due to “failure to progress” or repeat cesareans.

v However, decisions to perform c-sections are often influenced by many non-medical factors such as: individual philosophies and training, convenience for doctor or patient, patient’s socioeconomic status, peer pressure, fear of litigation, and financial gain.

What Are the Benefits of Cesarean Sections?

v For those true medical emergencies, c-sections have saved lives of both moms and babies. These instances would include:

· Complete Placenta Previa—the placenta is covering the cervix and opening

· Transverse position of baby—side lying

· Prolapsed cord—cord is preceding baby in birth canal

· Placental Abruption— the placenta partially or completely detaches from the uterine wall before birth

· Eclampsia or severe Pre-eclampsia w/ failed induction of labor

· Large uterine tumor which blocks the cervix

· TRUE fetal distress confirmed with fetal scalp sampling or biophysical profile

· TRUE Cephalopelvic Disproportion (CPD)—baby is too large or pelvis is too small. This is very rare and only happens with a pelvic deformity.

· Initial onset of an active Herpes infection in mother

· Uterine rupture

v Often c-sections are performed for instances that are medically “questionable”. These instances would include:

· Previous cesarean sections—VBACS (with a low transverse uterine incision) are safer in most instances for mom and baby. Approximately 180 women in the US will die each year from complications of an elective repeat c-section.

· Many cases of diagnosed CPD or fetal distress (the latter without confirmation through scalp sampling or the biophysical profile)

· Dystocia

· Failure to Progress (many interventions and medications can interrupt labor and cause this diagnosis)

· Breech—depends on the type of breech and the skill/experience of the doctor or midwife. Often it is much safer to try different means to turn the breech baby.

· Multiple birth

What Are the Risks of a Cesarean Section?

v A cesarean section is major abdominal surgery with risks to both mom and baby. The risks of the circumstance should always be thoroughly weighed against the risks of the surgery.

v Mom’s risks (resulting both directly and directly from this procedure) can be markedly increased. Half of all moms can expect some type of complication from this procedure. Risks include:

· Infection

· Hemorrhage

· Transfusion

· Hysterectomy

· Pulmonary Embolism

· Injury to surrounding organs and tissues (bladder, veinous system, etc.)

· Anesthesia complications (aspiration, paralyzation, death, etc.)

· Psychological complications (post partum depression; post traumatic stress syndrome, etc.)

· Delay in family bonding due to separation

· Longer recovery time

· Higher incidence in breastfeeding problems/failure

· Blood clots

· Paralyzed Bowel

· Scar Adhesions—Complications stemming from adhesions would likely be chronic and consist of: pelvic pain, bowel problems, and pain during sexual intercourse.

· Increased problems in subsequent pregnancies or fertility issues

o Marked increase in placental problems in future pregnancies due to scar tissue, etc.

§ Placenta Previa—placenta covers cervix

§ Placenta Accreta—placenta embeds itself too deeply in the uterine wall extending to the muscle tissue. Often requires a hysterectomy.

§ Placenta Abruption—placenta prematurely detaches from uterine wall

o Stillbirths

o Infertility and/or miscarriages

o Ectopic pregnancies

o Uterine Rupture

· Death—Mortality is 4 times as great than that of a vaginal delivery.

v Increased risks to baby cannot be dismissed either. These can include:

· Premature birth—even if the c-section was planned.

· Respiratory Distress Syndrome (in premature AND mature infants)

· Pulmonary Hypertension—5 fold higher incidences than babies delivered vaginally

· Jaundice

· Lower APGAR scores—50% more likely than vaginal births

· 1-9% of babies are scarred or maimed by the scalpel

What are My Alternatives to a Cesarean Section?

v Preventative measures and education is the key

o Freestanding birth centers and homebirth w/skilled midwife c-section rates are at or below the WHO standards. They also have statistically lower rates of infant mortality and morbidity. (it is not just a negligent “trade off”)

o Doulas can decrease your need for cesarean sections by 50%. It is also wise to take an independent childbirth course in your pregnancy; hospital courses typically teach society's "norm"--where a cesarean is "no big deal". Most independent courses focus heavily on cesarean prevention.

o VBACS are considered safer though many doctors are afraid of them because of fear of litigation suits. Eighty percent of women who have had a previous c-section could safely and successfully give birth vaginally. VBAC's are a rare occasion locally. Most doctors do not support them in this area. Many mothers report that their doctor seems supportive with a "trial" run, but when it comes down to it--the doctors will most likely find a "need" to perform a repeat section--either before or after labor begins.

o Take an "active birth" approach. It is best for mom and baby when mom is active during labor instead of bedridden. Utilize upright positions and avoiding the back lying position during labor. Being upright will help speed your labor and help baby rotate and descend into birth canal more easily. For those moms nearing a CPD diagnosis in labor, the squatting birth position allows your pelvis to open an additional 33 percent.

o Breech babies can often be turned by external version, chiropractic techniques, etc. If unsuccessful, the type of breech and the experience/skill of the care giver should be considered; then, weigh the risks of the breech birth vs. the risks of the c-section.

o Avoid factors during labor which could contribute directly or indirectly to the likelihood of a c-section.

· Use of Pitocin, etc. (increases the chances of fetal distress, and in less common instances, uterine rupture)

· Epidurals—often will stop or slow labor down and inhibit the ability to push

· Routine continual electonic fetal monitoring—have not increased the healthy outcomes of babies but HAVE increased the chances for mom “needing” a c-section

· Frequent vaginal exams—which could lead to infection, thereby making the doctors want to deliver soon—whether mom is “close” or not…..

...If We Do Nothing?

v If nature is let run its course without interventions, without time limits, etc. , 95% of babies and moms would birth with no “true” complications.

Helpful Links and Information:

WHO | World Health Organization World Health Organization