Caesarian Sections

The Caesarian section can be a life saver for both the mother and her baby.  There are a number of conditions which can develop during pregnancy or during the delivery process which require that the baby be delivered by C-section.  Among them are shoulder dystocia, fetal distress, failure of the labor to progress, malposition of the baby and a baby too large for the pelvis of the mother.  But Caesarian section is not risk free and the evidence is that it is being used when it is not necessary.  This is a serious problem.

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So what are the risks of a Caesarian section?  In the first place, all of the usual risks of an operation are present:  bleeding, infection, clotting problems, reactions to anesthesia, and surgical accidents.  Mothers who have had C-sections are also usually in the hospital longer and face larger medical bills.  Their recovery takes longer than that of the average mother who has delivered vaginally.  Pain levels may be greater due to the surgical incision.  Finally, there is an increased risk to future deliveries.  While it is possible to deliver a later baby vaginally after having had a C-section, there is a greater risk of uterine rupture during labor.

C-sections present some risk to baby as well.  Babies delivered by C-section are more likely to develop breathing difficulties.  There is also a chance baby will be nicked by the surgical instruments during the procedure.

All of these risks are greatly outweighed, if either the mother’s health or that of the baby are in danger with the continuation of labor and a vaginal delivery.

Since doctors began to keep records of the number of C-sections being performed, the numbers have been going up.  Beginning particularly in 1996, there has been a sharp rise in the percentage of Caesarian births.  In 1996, one in five women had a C-section.  Today that number is one in three.  That is approximately a 65% increase.  If C-sections are being performed to save the mother or the baby from a risk, we would expect to see decreases in maternal and fetal injuries and death.  Unfortunately, there has been no such decrease.  C-sections are clearly being performed for reasons other than the safety of the mother or the baby.  When not done to protect the mother or the baby, a C-section presents greater risks to both of them than a routine vaginal delivery.  For this reason, the American College of Obstetricians and Gynecologists (“ACOG”) has offered guidance to obstetricians about the risks of the procedure in an effort to discourage its use when not necessary to protect either the mother or the baby.

There is no agreement on the reason so many more women get C-sections than in the past.  It does not appear that there are more risky pregnancies or that women are more frequently demanding a C-section.  One factor that some observers have remarked upon is our old friend “fee for service.”  Obstetricians are usually paid for more a Caesarian section delivery than for a vaginal one.

What does all of this mean for the woman approaching labor?  My advice is to think about these issues before arriving at the hospital.  Every0ne hopes that the delivery will go smoothly and the vast majority do.  However, babies have a way of acting unexpectedly and the mother and her partner, if he or she is there, must be prepared to be flexible and to make decisions as the situation changes.  To those mothers who really want a natural, vaginal delivery, I say, “Don’t let that desire outweigh the safety of your baby.”  Don’t delay the decision to go Caesarian wait too long.  The obstetrician should be closely monitoring the situation but don’t count on her or him to the point that you risk the health of your baby.  This is your baby. Ask questions and be proactive.  Lean on your partner.  After hours of labor, you may not be in the best place to ask questions and make decisions.  Have someone there to help you, if possible.  Most of all, good luck.  Mothers have been delivering babies for thousands and thousands of years.  You have the best medical technology available to you in the history of mankind.  Everything should be fine.


Posted in Birth Injuries, Cesarean Section, Fee for Service, Health Care Costs, Infection, Informed Consent, Sepsis |