C-sections in the News
(To
normalize breastfeeding, we must first start by
normalizing birth)
The C-section rate in the U.S. is at a record
high – 29.1% in 2004, over a 40% increase in
eight years. Two years later, in 2006, it’s
likely higher. A 2005 national survey of
women’s first childbirth experiences (Listening
to Mothers), revealed a cesarean rate of 31.4%,
not even counting moms who gave birth to twins
or more.
The Myth of Choice
Think this dramatic increase is because women
are demanding it? Think again.
In the 2005 survey, only one woman among
1315 asked for a c-section for a non-medical
reason. If this were the whole population of
the U.S., it would mean only 2,616 out of over 4
million women who gave birth for the first time
had a c-section simply because they wanted it.
Yet the same survey revealed that 9 percent of
women were pressured from their provider to have
one.
So why do we keep hearing that the medical
community is simply giving women what they
want? The answer is complicated, involving
legal, financial, political and social factors.
Moreover, if physicians really believed in
“maternal choice,” shouldn’t women have a right
to refuse surgery? Some of the same
doctors who argue for a surgical choice,
vehemently oppose a woman’s choice for a VBAC
(vaginal birth after cesarean). In fact, over
300 hospitals around the country have now banned
VBACs, forcing many women to have surgery
against their will. The implications are huge,
especially for women who want a large family.
What’s at Stake?
Childbirth Connection (formerly known, since
1918 as the Maternity Center Association)
conducted a well-respected systematic review of
all the best studies that have compared the
risks and benefits of vaginal birth to the risks
and benefits of cesarean births. The
differences were huge! C-sections carry extra
risks to the baby, the mother, and even her
future pregnancies and babies. Consumer Reports
has even ranked c-sections as number three on
its list of “12 surgeries you may be better off
without.”
Ranking the risks from very low to very high the
review identified 33 areas where c-sections were
more risky than vaginal births (including risks
that are life threatening, such as hemorrhaging
and bowel obstruction), yet only 4 areas where
vaginal births were more risky than c-sections.
And those risks were often temporary, e.g.,
perineal pain and incontinence.
Risks to Moms. Some of the risks
to the mom most likely to occur from a
c-section include accidental cuts to nearby
organs, longer hospital stays, more intense and
longer lasting pain in the post-partum period,
developing an infection, rehospitalization, less
early contact with her baby, dissatisfaction
with her birth experience, and psychological
trauma.
Risks to Babies. Risks to babies include
a greater likelihood of being cut, of having
respiratory problems, and of developing asthma.
Studies also show that babies born by c-section
are less likely to be breastfeeding several
weeks later.
Future Risks.
Many show up with later pregnancies.
Infertility, ectopic pregnancies (where the
embryo develops outside the uterus or within the
scar ); dangerous problems involving the
placenta (where it attaches near or over the
cervical opening, grows through the uterine
lining, or detaches from the uterus before
birth,); and uterine rupture (where the uterus
gives way, especially at the site of the scar,
increasing the risk for severe bleeding, shock,
and other emergencies) are all more likely with
c-sections, as is the risk for having a baby
born prematurely or stillborn. And the more
c-sections a woman has, the greater the risks.
And the studies keep coming.
A recent study in
France revealed that women who gave birth via
cesarean section were more than three times
likely to die as a result of the procedure
compared to women who gave birth vaginally.
(Obstetrics & Gynecology 2006; 108: 541-8)
The Bottom Line
If you are hemorrhaging or the baby isn’t
getting enough oxygen, a c-section can literally
be a life saver. But women are ending up with
c-sections without being made aware of the
risks. And a “choice” without it being an
informed one, isn’t really a choice at all.
All patients, including women in labor, have the
right to “informed consent,” both for
themselves, as well as their babies. But long
before walking through that hospital door,
pregnant women must learn about the risks of
unnecessary surgery, along with what they can do
to reduce the likelihood of ending up with one.
Fortunately, the choices we make prenatally can
help protect us.
For More
Information
If your hospital has
banned VBACs, ICAN,
International Cesearean Awareness Network,
can help you understand your patient rights,
including the right to informed consent and the
right to refuse an unwanted medical procedure. |
