It is only natural for women to fear childbirth. First-time moms face the unknown, while repeat mamis have a pretty good idea what they are getting into! All of us know complications may arise at any moment during labor, leaving no option but an emergency C-section. Yet now, more and more women are requesting their doctors perform a cesarean to avoid a natural vaginal birth.
According to the most recent data available from the Centers for Disease Control and Prevention (CDC), nearly 1.4 million babies, or 32.8 % of deliveries, were by cesarean in 2010, the highest rate ever in the United States. Following a slight decline in the mid 1990s, C-section rates began escalating at an increasing pace, with a 71% rise since 1996, for mothers of all ages and all ethnic groups. So it is hardly a surprise it has become the most common surgery performed in American hospitals.
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The World Health Organization guidelines suggest that only 10-15% of all deliveries should be via C-section. This would cover the cases where it is medically necessary to perform a C-section, whether planned or as a result of an emergency. As explained by Womenshealth.gov, these situations include:
- When the mother is carrying more than one baby: twins, triplets, etc.
- Health problems in the mother including HIV infection, herpes infection, and heart disease.
- When the mother has dangerously high blood pressure.
- When there are problems with the shape of the mother’s pelvis.
- Problems with the placenta.
- Problems with the umbilical cord.
- Complications due to the position of the baby, such as breech or transverse positions.
- When the baby shows signs of distress, such as a slowed heart rate.
- If the mother has had a previous C-section (though it is possible to have a vaginal delivery after a cesarean in some cases).
Without medical indication, the women’s right to choose a C-section is a source of ongoing controversy among doctors. Fear over the pain of childbirth, the desire to avoid possible long-term consequences of a vaginal birth or the perception of having greater control over the delivery are among the reasons driving women to request a cesarean, according to the American College of Obstetricians and Gynecologists (ACOG). However, ACOG, the nation’s largest ob-gyn organization, recommends that women have a vaginal birth in the absence of medical necessity for a C-section. Maternal-request cesareans should be avoided by mothers who plan to have several children, they add, and never performed before 39 weeks of pregnancy unless there is a medical need.
Doctors have also been pushing this delivery method for the wrong reasons, say advocates for mothers’ rights, who suspect an economic incentive can explain part of this trend. And while labor is unpredictable, a planned cesarean offers the convenience of scheduled surgery and actually reduces the doctor’s chances of facing malpractice suits. Generally courts see no negligence in a doctor who evaluates the risk and opts for a C-section, even if it can later be argued that it was unnecessary. However, a doctor can be liable for failing to discover a risk factor and not performing a C-section, when labor results in injuries to the newborn or mother.
RISKS INVOLVED IN C-SECTIONS
Some doctors defend the mother’s right to choose how she wishes to deliver her child, once the risks and benefits associated with having a C-section are understood. A C-section is major surgery, with an incision made in the mother’s abdomen—usually the so-called bikini incision side to side—and another to open the uterus, just wide enough for the baby to fit through.
Compared to vaginal births, cesareans require longer hospital stays and have painful recovery periods. Specific risks for the mother, as listed by March of Dimes include:
- Infection in the incision, in the uterus or nearby organs.
- Reactions to medications, including the drugs used for anesthesia.
- Injuries to the bladder or bowel during surgery.
- Blood clots in the legs, pelvic organs or lungs.
- Higher risk of complications in future pregnancies, including: placenta previa and uterine rupture.
As for the child, those born by C-section tend to have more breathing problems. Any baby born before full-term is more likely to suffer complications, such as respiratory distress and failure, pneumonia and admission to neotatal intensive care. Babies born between 37 and 39 weeks are known as early-term, and pre-term if born before week 37. Cesarean deliveries contribute to the large number of babies being born before the 40 weeks of pregnancy are completed, since doctors schedule this procedure early to prevent the mother from going into labor spontaneously.
DIFFERENCES STATE TO STATE
The chances of one or other delivery method also depend on where you live. C-section rates vary greatly within the US states. According to the most recent data from the CDC, Louisiana had the highest percentage of cesareans performed in 2010, with 39.7% of all births, followed by New Jersey with 38.8%. Florida is another state on the higher end, with 37.8% of babies delivered by C-section, while California falls on the average for the US. The states with the lowest cesarean rates are New Mexico and Alaska, with 22.8% and 22.6%.
Regardless of the delivery method, giving birth is a very personal experience and every mami has her own story. We would love to hear yours if you would like to share it with us!