Better Health & Living

Issue: April 2008
Too Many C-Sections?
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Too Many C-Sections?

by Susan Flagg Godbey

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Nearly one in three American women deliver their babies via Caesarean section, says a recent survey by the Centers for Disease Control and Prevention. The reason for this all-time high for surgical births: Convenience…and fear of pain.

“More women are requesting C-sections than ever before because they want to schedule the birth, rather than waiting and not knowing when labor will start on its own,” says Bruce Flamm, MD,  a clinical professor of obstetrics and gynecology at the University of California, Irvine and author of Birth After Caesarean: The Medical FactsBirth After Caesarean: The Medical Facts.  “Others are worried that it will be too painful, or that their pelvic floor muscles will be damaged during birth. These are all legitimate concerns, but it’s important to look at the facts.”

According to the World Health Organization, C-section is still riskier than a vaginal delivery; a woman’s risk for serious complications can be up to three times higher than with a planned birth and a baby’s odds for breathing problems rise if born before 39 weeks. And while elective C-sections are on the rise around the world, US officials are trying to cut the US rate to 15 percent, the number that experts say are medically necessary.

If you’re considering a C-section, here’s what you need to know:

I do want to avoid childbirth pain and incontinence in the future. Isn’t C-section my only choice? 

If you’re worried about pain, think about this: A C-section is major surgery. It’s not pain-free. You’ll have a big incision that has to heal and you’ll need pain medication for several days afterward. And you can get pain medication. Many doctors and hospitals give epidurals early in labor, so there’s little pain.

Also, it’s not that clear that vaginal birth really raises your risk for incontinence any higher than a caesarian section. Too many people have jumped to that conclusion, but when you look at women 1, 2, or 5 years after a birth, the rates aren’t that different. And when researchers compare women who’ve never given birth to those who have, incontinence rates are similar. So I don’t think we can assume that a C-section will protect you from incontinence later on.

My doctor is pushing me to have a C-section and I don’t really want to. What should I do?

There are many reasons your doctor may suggest a C-section. You may be in a situation where surgery could save your life and/or your baby’s. For example, there may be a risk that the baby won’t receive oxygen and blood from the placenta during the entire birth or that you’ll experience extremely heavy bleeding. What you can do is talk to your doctor, as well as to the nurses and midwife in the practice, about whether it is necessary or whether it would be safe for you to try labor. You may also want to get a second opinion from another obstetrician.

If I’ve already had a child by C-section, can I safely have a “normal” birth with my next baby?

Often the answer is yes. When we studied 1,913 women who were attempting what’s called Vaginal Birth After Caesarian Section (VBAC) at a birthing center, we found that 24 percent had to be transferred to hospitals due to complications and that most complications happened to women who had had more than one previous C-section or whose babies were overdue—their pregnancies had gone to 42 weeks or more.

Your first step is to talk with your doctor about it during your first trimester. So often, these things get put off until it’s too late. Your doctor may want to get the records of your previous births to be sure you’re a good candidate for VBAC and to plan the birth. It can go very well. I did a VBAC last night and it was an almost 10-pound baby. The mom is very happy and will be going home with her new baby in just a few hours.

Can I prevent a C-section if my labor isn’t going well? 

The best thing you can do is to tell the doc and nurses that you’d like to do everything possible to have a normal birth. That can really set the tone so that everyone works with you.

That said, a C-section may be the best choice when labor isn’t working out or the baby is in distress.  It’s important not to see this as a failure on your part. Sometimes, you can do everything right leading up to the birth and still need surgery in order to finish the birth with a healthy baby and a healthy mother. And that’s the most important thing.

By Susan Flagg Godbey and the Editors of Better Health & LIVING®

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