Whether you are pregnant, have been pregnant in the past, have a friend that is pregnant, or you are of child bearing age – you might wonder if you will have a cesarean section in your future. Heck, the odds right now are pretty good that you very well might. Approximately 1 in 3 women have a c-section – the most common operating room surgery performed in the US
You may even wonder if a c-section is safer or easier then having a baby the old fashion way.
A report published (DEC 2012) analyzes the available published research to compare health outcomes between cesarean delivery and planned vaginal birth. This report was developed to support the effort of the National Priorities Partnership (NPP) which is a group of 52 major national organizations with a shared vision to achieve better health and their goal of reducing c-sections in low-risk mothers in half - to 15%.
This is what the assessment found:
This is what the assessment found:
Key: (of every 10,000 women or babies)
Moderate = 10 to 99
Large = 100 to 999
Very Large = 1,000 to 10,000
The physical effects in women following a cesarean deliver
Cardiac arrest: Limited evidence suggests that a MODERATE excess number of healthy women may experience cardiac arrest in association with cesarean delivery compared with similar women planning vaginal birth.
Urgent hysterectomy: A SMALL to MODERATE excess number of women having initial cesarean delivery undergo unplanned hysterectomy compared with women having vaginal birth.
Thromboembolic events (blood clots): A SMALL to MODERATE excess number of healthy women having cesarean delivery experience a blood clot.
Anesthetic complications: Limited evidence suggests that a MODERATE excess number of healthy women having cesarean delivery may experience complications with anesthesia compared with similar women having spontaneous vaginal birth.
Major infection: Limited evidence suggests that a MODERATE to LARGE excess number of healthy women having planned cesarean delivery experience major puerperal infection compared with women having or planning vaginal birth.
Wound infection (cesarean or genital): A LARGE excess number of healthy women having cesarean delivery have wound infections compared with women planning vaginal birth.
Hematoma (cesarean or genital): Limited evidence suggests that a LARGE excess number of healthy women having cesarean delivery have wound hematomas compared with women planning vaginal birth.
Length of hospital stay: Planned cesarean delivery increases length of hospital stay by at least 0.6 to 2 days compared with planned vaginal birth.
Hospital readmission: A MODERATE to LARGE excess number of healthy women having cesarean delivery require readmission to the hospital.
Problems with physical recovery: With the exception of the presence of hemorrhoids, which are more common with vaginal birth, a LARGE to VERY LARGE excess number of women having cesarean delivery experience problems with physical recovery, including general health, bodily pain, extreme tiredness, sleep problems, bowel problems, ability to carry out daily activities, and ability to perform strenuous activities, compared with women having spontaneous vaginal birth.
Chronic pelvic pain: More women experience chronic pelvic pain after cesarean delivery than after vaginal birth, but the excess number cannot be calculated from the studies examined.
The effect on babies delivered via cesarean
Respiratory distress syndrome: When birth occurs before 39 weeks, more babies born by cesarean than by vaginal birth experience respiratory distress syndrome (RDS), but the excess number cannot be calculated from the studies examined.
Pulmonary hypertension: Limited evidence suggests that a MODERATE excess number of babies delivered by elective cesarean may develop pulmonary hypertension.
Asthma: Cesarean delivery increases the likelihood of developing asthma in childhood, but the excess number cannot be calculated from the studies examined.
Type 1 diabetes: Cesarean delivery increases the likelihood of developing Type 1 diabetes in childhood, but the excess number cannot be calculated from the studies examined.
Allergic rhinitis: Cesarean delivery increases the likelihood of developing childhood allergic rhinitis, but the excess number cannot be calculated from the studies examined.
Symptomatic food allergy: Limited and conflicting evidence suggests that cesarean delivery may increase the likelihood of developing food allergy in childhood, but the excess number, if any, cannot be calculated from the studies examined.
Obesity: Limited evidence suggests that a LARGE excess number of children delivered by cesarean may be obese at age 3.
The complications resulting in cesarean delivery
Operative maternal injury: Among women having first delivery via cesarean, a MODERATE number of women experience bladder puncture, and a SMALL number experience bowel injury or injury to a ureter.
Surgical cuts to the baby: Limited evidence suggests that a MODERATE number of babies are cut during cesarean delivery.
Re-operation: Limited evidence suggests that a MODERATE number of women having cesarean delivery require re-operation.
Persistent pain at the site of the cesarean incision: Limited evidence suggests that a LARGE to VERY LARGE number of women still experience pain at the incision site 6-10 months or more after cesarean delivery.
Cesarean scar endometriosis: Limited evidence suggests that a SMALL to LARGE number of women having cesarean delivery develop cesarean scar endometriomas.
Cesarean scar ectopic pregnancy/early placenta accreta: Some women becoming pregnant after cesarean will experience a cesarean scar ectopic pregnancy or placental implantation within the uterine scar, but the number cannot be calculated from the studies examined.
Dense intra-abdominal adhesions: Limited evidence suggests that a VERY LARGE number of women develop dense adhesions after cesarean delivery.
Complications unique to vaginal birth
Anal sphincter injury: A LARGE number of women experience anal sphincter injury at vaginal birth.
Perineal or genital lacerations of any degree: Exclusive of episiotomy, a VERY LARGE number of women experience trauma to the perineum or genitals at vaginal birth that requires suturing.
Persistent perineal pain: Limited evidence suggests that a LARGE number of women experience persistent perineal pain lasting at least six months with spontaneous vaginal birth, and a VERY LARGE number of women experience perineal pain lasting at least six months after instrumental vaginal delivery.
Potential effects of cesareans on women in future pregnancies and births
Voluntary infertility: A LARGE to VERY LARGE excess number of women choose not to conceive again after cesarean delivery.
Placenta previa: A SMALL excess number of women with first delivery by cesarean develop placenta previa in the next pregnancy, but the excess number cannot be calculated from the studies examined. A LARGE excess number of women develop placenta previa after two or more prior cesareans.
Placenta accreta: A SMALL excess number of women with first delivery via cesarean develop placenta accreta in the next pregnancy. A LARGE excess number of women develop placenta accreta after multiple prior cesareans.
Placental abruption: A MODERATE excess number of women with first delivery via cesarean have a placental abruption in subsequent pregnancies.
Hysterectomy: A MODERATE excess number of women with prior cesarean delivery require an urgent hysterectomy during the next delivery admission compared with women with only prior vaginal birth. Limited evidence suggests that the excess increases with subsequent pregnancies.
Uterine rupture: A MODERATE excess number of women will experience uterine rupture with prior cesarean delivery compared with prior vaginal birth.
Intensive care admission: Limited evidence suggests that a LARGE excess number of women with prior cesarean are admitted to intensive care at the next delivery compared with women with prior vaginal birth.
Hospital readmission: Limited evidence suggests that a MODERATE excess number of women with prior cesarean are readmitted to the hospital after discharge at the next delivery compared with women with prior vaginal birth.
Conclusion
This data supports efforts for women to strive to avoid a c-section and reduce the rates for future generations.
I do believe it is worth noting that not all women will be able to deliver their babies vaginally - a c-section, in some cases, is the only safe option for delivery. Because of this, we must continue to give all women support and encouragement no matter how a baby was born – avoid judgment and condemnation at all costs.
We must unite as one front to effectively alter the rate of cesarean surgery for all women and our daughters.
Because how you give birth can not only effect a mother, but also her baby and future babies – it is important to gather information and understand the options before being faced with situations/events that will increase risk of surgical birth.
Here are a few ways to reduce the chances of having a c-section:
Ask hard questions – Don’t be afraid to interview prospective OBGYNs. Ask them what their c-section rate is. Don’t be afraid to ask whether the doctor is knowledgeable about natural/low intervention childbirth. Be inclined to contact the local hospital and ask for recommendations!
Plan ahead and be clear – Don’t plan on presenting your birth plan the day of your actual birth! Discuss your plans during all your prenatal visits. Be very clear and continue to re-affirm your goals to everyone involved.
Don’t be induced – This one is important! As tempting as it might be in those last few weeks and days of pregnancy, never ask to be induced or give into the pressure to electively induce (unless medically needed).
Hire help – Hiring a doula has been known to increase the chances of vaginal and low-intervention birth. If you can’t afford one, still contact one and they may offer other payment arrangements. Many doulas believe that everyone woman should be supported during labor – no matter what.
Eat like you mean it – So you are serious about avoiding a c-section? Well, consider striving for the most optimal food and supplements. Eating nutrient rich foods help women reduce the risk of having a c-section (predominantly because it reduces your likelihood of gaining too much weight during pregnany – despite the common saying, you are NOT eating for two). Also consider something more then just a prenatal vitamin. Studies have been published illustrating that higher levels of vitamin D consumed during pregnancy may enhance your chances of a vaginal birth. Sign me up!
Reference:
Read the report here-
Check out more on-
A complication I had from my c-section was a kinked fallopian tube. When they do a c-section, after the baby and placenta are removed, the entire female reproductive system is brought outside the body. The uterus is stitched up, the ovaries are tucked behind the uterus, and everything is reinserted, then the rest of the tissue and skin is stitched/stapled. Under normal circumstances, the ovaries migrate back to normal position (not sure if the physician assists with this or not). In my situation, my right ovary moved back to normal position, whereas my left ovary stayed behind the uterus. I did not know this until I got a Mirena IUD inserted and they had to confirm proper placement via ultrasound, and couldn't find my left ovary. They eventually did. But I know for certain that the ovary was not out of position prior to the c-section because they visualized the ovary in normal position during the pregnancy. Result: it took quite a long time (7 years- not that we were actively trying the whole time) to conceive our second child, seeing as functionally, I had only one working ovary, whereas for the first pregnancy, we conceived on the first try. I'm currently 34 weeks along in the pregnancy with our second child. I am certainly opting for VBAC this time, as I don't want to compromise my fertility again, and also, VBACs are so much safer than repeat c-sections.
ReplyDeleteThank you so much Candace for sharing your story!
DeleteThe absolute last thing I want to do is make women fearful of birth - I hope this post informs and empowers.
Women have much more control over birth then they realize..and although c-sections have the ability to be life-saving in some cases, it also carries certain risks over natural, vaginal birth.
Good luck with your VBAC !!!