As the frequency of which women are having cesarean births increase, I have found a correlating increase in the amount of complacency in which the general public feels about cesareans. “What is the big deal?” I hear people say, “It’s just another way for babies to be born”. Although the benefits of having a cesarean section are widely offered, little is said about the varied and increased risks associated with this mode of delivery.
I do believe that women are blessed to have the option of cesarean surgery, but I also believe that we need to understand the complete truth of what we are getting ourselves into. As one in three women (and sometimes more depending on the location) are giving birth by cesarean, they need to know the truth about the significance of their decision, and the small details on the consent form they sign before heading into the OR.
In fact, less than three years ago, Consumer Reports named cesarean section number three on its list of “12 Surgeries You May Be Better Off Without.” They recommend that women “check out safer alternatives” before having a cesarean.
One report suggested that when comparing vaginal birth to planned cesarean section (including when a woman schedules a cesarean after having had a previous cesarean) that the babies generally do about the same, but that 8 in 100 women will have serious complications as a result (see article below).
Here is a simple breakdown of the risks associated with cesarean section, as compared to vaginal delivery. These rates are backed up by legitimate medical studies, of which I have attached links at the bottom of this post.
Maternal risks during current cesarean and recovery:
1. Four times more likely to die than women having a vaginal birth
2. Infection of the incision or uterus 4.4 times more likely than after a vaginal birth
3. Hemmorage – blood loss is about twice as much as in a vaginal birth, and 1 in 6 women having a cesarean require a blood transfusion
4. Decreased bowel function following delivery
5. Maternal respitory problems as a result of anesthesia, including pneumonia
6. Reactions to anesthesia and other surgical medications, such as a sudden drop in blood pressure, one article linked below reported cardiac arrest as a risk of epidural anesthesia during cesarean section
7. Additional surgeries to correct mistakes made during the cesarean, such as bladder repair (1 in 50 women)
8. Blood clots in veins, which can travel to the heart and cause a heart attack, are 5.5 times more likely than after a vaginal birth
9. Nausea and vomiting
10. Severe headaches
11. Hysterectomy – more than 7 times as many women have/require a hysterectomy immediately following a cesarean than those who had a vaginal birth
12. Adhesions in the uterine scar causing various complications, occuring in 52-73% of women after a cesarean
13. Emotional reactions are varied and stronger, including postpartum depression
14. Extended recovery – 1 in 14 women who had cesareans report pain 6 months following birth
Fetal Risks During Cesarean and Later in Life:
1. Premature birth leading to various complications, some as a result of lung immaturity. A recent study linked below reported that the recent drastic increase in singleton preterm delivery of babies 34-36 weeks is due almost entirely to being born by cesarean surgy
2. Immediate breathing problems such as tachypnea are twice as likely
3. Lower apgar scores – cesarean-born babies are 50% more likely to have low apgar scores than vaginal-born babies
4. Fetal injury during surgery – 1 or 2 per 100
5. Increased need for the neonatal intensive care unit – 9.8% of babies compared to 5.2% of vaginal-born babies
6. Mother-baby bonding issues
7. Less likely to be breastfed. One study linked below reported that cesarean-born babies were three times more likely to be weaned from breastmilk by the age of one month, indicating the difficulty of which cesarean mothers have in initiating breastfeeding after major surgery
8. Fetal death is almost 3 times more likely after a cesarean
9. Low birth weight
10. 52% more likely than vaginal-born babies to have asthma later in life
Maternal Risks in Pregnancies and Births following a Cesarean:
1. Infertility or reduced fertility. 52-73% of women develop adhesions following a cesarean. These adhesions often result in infertility
2. Uterine rupture. 1 in 1,000 women will experience uterine rupture during a trial of labor after cesarean, although it occurs just as frequently in women during a pregnancy following a cesarean, without trial of labor
3. Placenta previa (placenta grows over cervix) is 5 time more likely after a cesarean
4. Placenta accreta, increta, or percreta (the placenta grows into or through the uterine wall) is especially dangerous as 40% of women who experience it require at least 10 units of blood transfusion, nearly all have hysterectomies, 1 in 11 babies die and 1 in less than 14 mothers die. Accreta and percreta occur in nearly 1 per 100 cases of cesarean birth after at least one prior cesarean, compared to 1 per 1,000 in an unscarred uterus. The risk of both previa and accreta occuring at the same time is 35 times higher for a woman after a cesarean than with an unscarred uterus
5. Ectopic pregnancy is 50% more likely after two or more cesareans
6. Difficulty having a future vaginal birth. Although 60-80% of women who attempt a vaginal birth after cesarean can succeed, economic, social, and legal issues among other things, have brought the VBAC rate to less than 10%
7. Placenta abruption (where the placenta detaches from the wall of the uterus, which can lead to fetal death, is 2-4 times more likely to occur after a cesarean
Risks to future children relate to the frequency in complications in future pregnancies, and the increased potentional of being born by cesarean with it’s risks.
Sources:
Mayo Clinic: Complete Book of Pregnancy and Baby’s First Year
http://www.childbirth.org/section/CSFact.html
http://www.medicalnewstoday.com/articles/39907.php
http://www.midwife.org/siteFiles/news/REDUCEMarch20NewsRelease.pdf
http://www.medicalnewstoday.com/articles/41247.php
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102272723.html
http://linkinghub.elsevier.com/retrieve/pii/S0002937806006077
http://www.medicalnewstoday.com/articles/35499.php
http://www.springerlink.com/content/b4n16184k2216557/
http://cat.inist.fr/?aModele=afficheN&cpsidt=3924351
http://besttreatments.bmj.com/btuk/conditions/1000766857.html
http://www.sciencedaily.com/releases/2008/05/080528095746.htm
http://www.medicalnewstoday.com/articles/108888.php
http://www.plus-size-pregnancy.org/CSANDVBAC/bfaftercesarean.htm
http://www.pregnancy-info.net/c-section_adhesions.html
http://parenting.ivillage.com/pregnancy/plabor/0,,bgjt-p,00.html
http://www.mommyguide.com/modules.php?op=modload&name=News&file=article&sid=48
It’s about time women wake up & learn to trust their bodies. They were built for delivering babies! It should be mandated that c-sections are only available if there is a medical reason for it. Why put yourself and child at risk if you don’t have to?!?!
By: MrsK on July 30, 2008
at 3:10 pm
Thank you for this article!!.. I think that its great and I like
all the references too! I agree with tthe previous comment, women should ONLY be given the oppertunity to have a c section if it is medically nessacary.
Also Doctors should not offer C sections for thier own convinence, not that all do but I have heard stories of them doing that.
I think that the C section stats are linked to induction rates too! Docotrs are deciding more and more to induce for what seems like the smallest reason.. more inductions and interventions cause more C sections!
Partlysbabe
By: Sally on July 31, 2008
at 11:25 am
Inductions absolutely have a lot to do with our high cesarean rate. Many inductions don’t work, which accounts for three out of the four cesareans that I have been a part of.
By: Naomi on September 15, 2009
at 2:06 pm
Thanks for the info and I am planning a VBAC this time around but I am quite sick of blogs like this who make it seem like we all “choose” to have a c-section. I did not have one single problem, nor did my son, and actually had a 9 and 9 for apgar scores. My c-section was unexpected, but needed. These “statistics” are skewed to a certain point of view. That is the beauty of statistics…interpretation. It is a relatively safe surgery as far as surgery goes. You have a better chance of getting killed or maimed by crossing the street.
By: Mandy on July 31, 2008
at 11:47 am
That is true that not all women who have cesareans chose them. Many are for medical reasons, which is what I stated in the post. And it is also true that you are more likely to die or be maimed by walking accross the street. But the statistics are still true, they are not skewed, those women they represent actually died or had serious complications as a result of the surgery. I know that a lot of people will write about the dangers of cesareans and not of VBAC, but the reason I chose to post this information is because what most women are told when the visit their doctor is the opposite, they are not told of the risks of cesareans, and they need to hear them so that if they are given an option for a cesarean that is not necessarily needed, they can make the decision that is based on knowledge of both cesareans and vbacs or whatever the case may be.
By: Naomi on September 15, 2009
at 2:06 pm
Mandy – I am a mom of 2 (3# on the way) and my first was a vaginal delivery via induction because I went to 42 weeks showing no signs of progress from weeks 39-42. I was 1cm dilated at 42 weeks. It was the same way with baby #2 – only this time I had a different OB from the same center. This doc had estimated fetal weight u/s’s done from weeks 38-41. At week 38 the baby was measuring at just over 8lbs, at week 39 the baby was coming in at 9.5lbs, at week 40 the baby was showing 10lb 12oz, at week 41 the baby was showing 12lbs. My doc could have induced me at 39 or 40 weeks but he chose not to and to allow the baby to get bigger and bigger. He told me we would schedule an induction at my 41st week apt and that would be on my 42nd week. The doc had my pitocin started for about 30 minutes, then he called (yes he wasn’t even there) and told me that he was afraid the baby would be too large and we would hurt the baby if we allowed for a vaginal delivery and said he was taking me off of the pitocin and scheduling a c-section. I told him from 30 weeks until that very morning several times that I did NOT want a c-section. He also knew that my previous pregnancy was induced for going over. He should’ve made the call at 39 or 40 weeks to induce if he was that concerned about baby’s size but he didn’t. I would up having a c-section and the baby was 9lb 15oz. No, he did not perform the c-section, my original ob did because he was on call and when he saw the baby her turned to me and said ‘I know you could’ve done this on your own’. I had nothing but trouble recovering from that c-section and I still have pain and can’t hold my pee. I never had any kind of incontinence after my vaginal birth of a nearly 9lb baby 2 years before and I never had any incontinence during that pregnancy. I now suffer severly from incontinence issues. I also can’t cough or sneeze without terrible sharp, pulling pain, stabbing pains right along my scar. They are terrible and sometimes bring me to my knees. Unless I want more surgeries, which I don’t, then there is nothing to do about it. I’m going for a vbac this time around.
I don’t think these statistics are skewed at all. For those women who had a great experience, and a quick recovery with no problems after, then I can see where you would think that it’s a simple surgery and it’s safe. There is a blog (I will try to find it and repost the link) of a woman, perfectly healthy who was pregnant with her first baby, stayed in the hospital for a month because her body way trying to deliver the baby from about 6 months along. She had her baby via c-section (I don’t know the reason why) but after the c-section the baby was taken to NEONATAL because it was a premie and she was in her room. She was unable to see the baby. After her 24 hours of bedrest post-surgery were up they came to get her to take her to her baby for the first time. Upon standing up a blood clot traveled to her heart and killed her. This was from her simple c-section surgery. She was a young, beautiful woman, in perfect health, who died in the hospital 24 hours after her c-section , never having been able to see the baby she struggled to keep inside until she could be delivered and able to survive.
I’m very glad you had a wonderful c-section experience and a great recovery, you are one of the lucky ones. However, don’t forget that there are women like me who didn’t recover well and were given a c-section when it wasn’t needed but rather for convenience. And please don’t forget the mother’s who had one and didn’t survive it.
C-sections should not be something that’s elective. You should not be getting pregnant if you don’t want to experience child birth. Most Hollywood ladies are electing c-sections because they have to work around a schedule or they don’t want to stretch out their vaginas, or are afraid of the pain of labor. This is not a good enough reason to risk your life or your babies. I also feel that inductions should not be done before 40 weeks just for convenience. There are many mother’s on my BabyFit board who have had inductions scheduled as early as 36 weeks just because they could, some of them have stated that their OB’s will not allow them to go passed 38 weeks. What? Isn’t a normal pregnancy between 36 and 42 weeks? In my opininon those doctor’s that are forcing and making it a practice to induce women once they reach 38 weeks should have their licenses removed.
By: Mary Ann on August 1, 2008
at 6:55 pm
I am really upset when people say that women are choosing C-sections. In fact this is far from the truth. My first son had the cord tightly around his neck and my doctor pushed for the C-section when I really didn’t need one. At the time I didn’t realize it. I just believed what they were telling me but it was strange that while they were in there they removed a simple cyst on my right ovary without asking me! It was in my medical records. They got paid for an additional surgery. This makes me wonder if they caused the complications to get the C-section. More $$$ for them! I just feel sick over it because I have a bad feeling about the whole thing. I feel like they took advantage of a first time mother. Then I wanted a VBAC with my second son. I had to search far and wide to find a doctor. So women are not choosing to have a repeat C-section, doctors are forcing this on them! Well I finally found a doctor, and I labored for two days and they said the labor was taking too long so they pushed the C-section again. My labor was progressing, but it was not going fast enough for thier clock. Again I feel cheated. I have nightmares and now my son is 1 year and the sorness is finally gone. I took longer than most women to heal. It was really bad for the first 3 months. People need to realize that women are not doing this, doctors are making it very hard to have a successful VBAC. These doctors are being too quick to use the knife. I am hurt and I don’t know if this pain I feel inside will ever go away. I just feel violated in every way. I want more children but I fear another surgery. The feelings are unbearable at times. Most people don’t understand. I am crying as I type this. I would love more children but I don’t know if I can endure being cut again.
By: Sarah on February 2, 2009
at 2:20 am
Maybe I should have put a disclaimer on this post saying that I do realize many women feel this way about cesareans. Your situation is certainly not unique (otherwise Silent Knife and Open Season would never have been written), and I am DEEPLY sorry for what happened to you. However, many other women do not feel the way you do and talk very casually about cesareans as if they are just another cosmetic surgery. I know several people personally who chose to have a repeat with no concern for the risks and side effects of choosing cesarean over vbac. Although you are right in feeling angry, I do hope you realize that this post was not meant for people who share your story, but for people who underestimate the importance of the birth path they choose.
By: Naomi on September 15, 2009
at 2:10 pm
wow sarah what you just wrote is ecactly how i feel…i feel that they manipulated my induced labor so i will endup having a surgery
my water broke and they said i have to be induced (even that the haed was fixed and that latest researches shows that watchful waiting is better then induction in most cases ….
the added more and more pitocin till i was a mass ,i couldn’t take it and the nurse said do u want drugs? i said is it metter if i’ll take now or later ? she said no u can take any time ,i asked what will be wiser epi or pethadine she said “i dont know” …i went for epi just because it’s name was familiar ,they gave it tome when i was only 4 cm dilated ! the rest is expected ,13 hrs letter with no progression c section !
why they do it to us ?,there is no freedom of choice as they say our babies going to die without their interventions ,which is not true -watchful waiting in most cases can be apply ,but they dont want this it is all about money!
i want more kids but im traumetized badly i dont know if i can do it ….i planed for big family ,now i dont know any more!
By: maya on March 14, 2009
at 12:50 pm
I feel sorry for every woman who shares a story with me like yours. And I do wonder why it is that doctors (or midwives) who practice outside of proven healthy practices are even interested in practicing. I do know that money is not the only factor, pride in bad habits learned from med school, fear of legal action and fear of the “worst case scenario” are also significant reasons why women are not always given the best care when giving birth in the hospital. But that doesn’t mean that all doctors practice this way. There are many excellent doctors who give prime care to women, care that respects, honors, and protects women. I have heard from other women who are afraid of giving birth because of past experiences with maternity care providers, but I must tell you, please do not think that you can’t have a good birth experience. Finding a supportive environment and a support care provider are the keys to having a good birth experience, along with self-education (not just watching a Baby Story and reading What to Expect When You’re Expecting) and a healthy lifestyle. I recommend that you read my article on Tocophobia: The Fear of Childbirth, and also look up the organization: ICAN (International Cesarean Awareness Network). They can give you more support in getting started to planning a VBAC. I also have some great videos on this blog related to VBACs. You can do it!
By: Naomi on September 15, 2009
at 2:12 pm