C-Section Basics
While C-sections are truly a lifesaver in many instances and highly recommended in others, in general, avoiding them is the way to go if at all possible. A CDC study published in the journal
C-sections are surgical procedures and carry risks that include the following:
Reaction to the anesthesia
Blood clots
Wound infection
Increased bleeding
Injuries to the bladder or bowel during the surgery
A longer recovery time
Increased risk of hernias due to the weakened abdominal wall
Adhesions (Fibrin, a natural defense to tissue damage, can adhere to organs, causing twisting and pulling in the abdomen and leading to infertility, pelvic pain, and bowel obstruction.)
In addition to these risks to the mother, babies born by C-section (especially if labor has not taken place prior to the procedure) are more likely to experience temporary breathing problems after birth. This condition, called transient tachypnea, requires medical attention. The labor and delivery process normally clears fluid from the baby's lungs and releases hormones that stimulate lung activity. Missing out on labor and delivery means these things don't happen, increasing the chances of problems. Babies born by C-section may be groggy due to the medication the mother receives during the surgery.
There is also a small risk of scalpel injury to the baby. Once you have one C-section, you are much more likely to need another one in a subsequent pregnancy. This is particularly true since evidence shows repeat C-sections may be safer than VBAC for many women and due to the fact that VBAC may not be available in all hospitals.
Previous C-sections increase the risk of placenta previa and placenta accreta in the pregnancies that follow. The more C-sections you have, the more scar tissue you build up, which can make future conception more difficult. Multiple C-sections also make the surgery more technically difficult, increasing the risks of prolonged surgical time, infection, and damage to other internal organs such as the bladder or the bowel.
If you have a C-section, ask your physician to use adhesion barriers. These barriers, which are not common in C-sections although they are for other abdominal surgeries, prevent the growth of adhesions that can cause many problems. Another request to make is for suturing of the peritoneum, the membrane that covers the internal organs. Often in C-sections it is left to close on its own, but a recent study showed suturing it prevents adhesions.
Another risk of C-sections is that your baby may be born too early. If your C-section is not preceded by natural labor and is instead scheduled or follows an induced labor, your baby may be slightly premature if the calculations used for your due date were not accurate. Preterm babies face the risk of jaundice, breathing problems, feeding difficulties, and an inability to properly regulate body temperature.
Generally, though, if your pregnancy is accurately dated, performing an elective C-section prior to labor can be done from 39 weeks on without concern about fetal lung immaturity. If you need a C-section sooner, or if the dating of the pregnancy is in question, an amniocentesis can check the baby's lung maturity. Women who are HIV-positive and who are having a C-section to prevent transmission of HIV to the newborn may have an elective delivery at 38 weeks, so that the C-section is performed before labor begins. The risk of the baby having respiratory problems is relatively low under these circumstances.
Patient-Choice C-Sections
Patient-choice C-sections (those done based on a patient's request, and not for any medical reason) have seemingly become popular in recent years. Many celebrities schedule them, and according to Health Grades, an independent health-care ratings agency, the number of women choosing patient-choice C-sections rose by 36.6 percent between 2001 and 2003.
However, these procedures are not nearly as popular as the media has portrayed them. One study showed that approximately 96 percent of women preferred a spontaneous vaginal delivery. Of the 4 percent who said they would prefer a C-section, the majority either had some type of risk factor that they thought made C-section safer for the baby or had a bad experience with a prior vaginal delivery.
Women who choose patient choice sections do so for a variety of reasons:
Fear of the pain or embarrassment of labor and delivery
A need to exactly plan the birth date for work or personal reasons
A belief that avoiding delivery will prevent bladder control problems later in life
A belief that delivery will change their vagina permanently, making sex different or less pleasurable
A belief that delivery negatively impacts the pelvic floor muscle tone
Fear that problems during delivery will harm the baby, causing problems such as cerebral palsy
The American College of Obstetricians and Gynecologists (ACOG) has issued a formal policy on patient-choice C-sections, saying it is ethical if it is in the best interest of the patient both physically and emotionally. Because of this policy, many physicians are willing to perform patient-choice C-sections.
Some of these reasons are valid, and some are not as valid. Some women are simply not able to face labor and delivery for a variety of reasons, and having the option of a C-section is important for them. Each woman has to make a decision about what is right for her personally, and she should be permitted to do so. Some women need to be able to plan an exact birth date due to pressing career, family, or personal reasons, and they should be supported in their need to do so.
It is also true that a vaginal delivery does stretch out vaginal tissue and that it can never be exactly as it was before. The vagina is designed to stretch, though, and any change is minimal. Most women find that they have normal, satisfying sex lives after a vaginal birth.
The information about pelvic floor changes causing a loss of muscle tone or leading to incontinence is conflicting. While there is evidence that vaginal birth can lead to these problems, the primary culprit is probably carrying a pregnancy. The weight of a baby on your pelvic floor for so many months is more likely to cause changes that lead to muscle tone changes or future incontinence.
While problems can occur during vaginal birth that can impact the baby, most problems are present before delivery, including increasing evidence that cerebral palsy is not caused by birth trauma. Some women see birth as a risky situation. While it is true that labor and delivery can be unpredictable, a competent physician can manage just about anything that happens. A C-section is not without risks either, so neither option is considered entirely risk-free.
A 2003 Gallup poll showed that one-third of female OB/GYNs interviewed said they would perform a patient-choice C-section if a patient asked.
Acceptance
No matter how you come to have a C-section, ultimately you have to accept the fact that you've had one and come to terms with it. Whether your baby exits your body through your vagina or through an incision in your uterus, you have still given birth and still have grown and nurtured a human being inside your body. You are a mother either way. The type of birth you have is a small part of your baby's history and does not mean you are any less of a woman or mother.
It is important to remember that both vaginal birth and C-section birth require stamina, courage, and commitment. Whichever you end up going through, you have accomplished something to be proud of.
