The advancement in medicine to the point where the cesarean section was developed is wonderful! Many moms have been saved, and many babies have been saved by this surgery. The problem with c-sections is not inherent in the surgery itself; it is in how we use it.
The problem with cesarean section birth is this: surgical birth is more risky than vaginal birth.
The risks associated with cesarean sections are low, as this surgery has been performed so many times as to allow physicians and surgeons to fine tune their surgical methods. However, the complication, death, and injury rates are HIGHER with surgical births than with vaginal births. Nature still knows best.
Complications of vaginal births exist. However, the risk of complications due to cesarean section surgery is higher. Statistics do not generally accurately reflect such complications as spinal anesthesia, breastfeeding problems as a direct result of anesthesia/mother-infant separation post op/fluid bolus in conjunction with spinal anesthesia/hemorrhage post op, psychological trauma, or anything which arises more than a few weeks after the surgery is performed. But statistics still show us that complication rates, maternal mortality and morbidity rates, and infant morbidity rates are higher with C-sections.
The most common complications arising from cesarean surgery are as follows.
Increased risks to women including:
- surgical mistakes [including injury of visceral organs by scalpel or other surgical instrument, most often to the intestines or bladder, and including retained surgical instruments or articles]
- scar separation
- placental problems
- stillbirth in future pregnancies.
Sometimes the infant is injured by the scalpel. Babies born by c-section also have higher risk of
- low birth weight
- respiratory problems
- cuts from surgery
Risks for future pregnancies include:
- higher incidence of ectopic pregnancies
- increased risk of uterine rupture in future pregnancies
- increased infertility rates
- increased rates of placenta previa and placenta accretia
- increased incidence of uterine rupture during labour and during the third trimester in subsequent pregnancies.
The Society of Obstetricians and Gynecologists of Canada endorses lowering the overall Canadian cesarean rate. In 2006, Canada’s C-section rate was 26.3% [Society of Obstetricians and Gynecologists of Canada]. This means that over 1 in 4 babies in Canada were born by Cesarean Section. In 2007, The United States’ C-section rate was 31.1% [National Center for Health Statistics, CDC].
An article by the American Congress of Obstetricians and Gynecologists (ACOG) states:
“For a low-risk childbirth that is progressing normally, C-sections require substantially longer recovery times and present greater risks of complications such as infection, bleeding, scarring, chronic pelvic pain, and damage to the intestines or bladder. C-sections also increase the risks during subsequent pregnancies, making a repeat C-section more likely. In 2007, research by the Canadian Perinatal Surveillance System found that elective C-sections have higher risks of anesthetic complications, major infections, obstetrical wound, and cardiac arrest. The study also notes that women who had an elective C-section were more likely to require an immediate hysterectomy due to bleeding. ”
The problem is not with Cesarean Sections themselves. The problem is in our OVERUSE of surgery to birth our babies.
One way to reduce C-section rates, which few seem to be advocating, is a more positive attitude towards trial of labour for repeat cesareans. Vaginal Birth After Cesareans (VBACs) have a 60%-80% success rate. The success rate for women trying to give birth vaginally with NO history of previous surgery is 73.7% in Canada. If the VBAC rate is 60%%-80%, I would say any VBAC has just about the same chance of delivering vaginally as a woman who ISN’T a VBAC. So why don’t we try?
This question has a complex answer. Baisically, there are two reasons that are most often given for NOT encouraging VBACs. One, there is an increased incidence of uterine rupture at the scar. Two, a woman who had ‘failure to progress’ or ‘Cephalo-pelvic disproportion’ is cited as likely to have it again in future labours, so to save her the grief of trying and failing again, and to save the medical system from unscheduled surgery (which is more costly and inconvenient from a medical standpoint), a repeat cesarean is recommended and surgery is scheduled.
Well, first of all there is an increased incidence of VBAC uterine rupture in the third trimester.
So, if we are going to advise women not to have VBACs because of an increase in rupture rates [women who have not had uterine surgery have a rupture rate of 0.01%. Those who have had c-sections have a rupture rate of 0.4%, which is a significant increase!], we should also advise them not to have any more pregnancies. This is not logical nor fair.
Second of all, the chance that a woman’s uterus will rupture is low. It is higher with VBAC than with normal vaginal birth, but it is still considered a rare event, just as serious cesarean complication rates are rare.
The second reason cited for advising against VBACs is that failure to progress or CPD will repeat itself. This is unproven statistically. Regardless of the reason for the first cesarean, the VBAC success rate is still 60%-80%.
Most women these days have 2 babies. This means that 13.15% of cesarean sections performed in Canada are repeat, elective sections (conjecture on my part). If we allowed all of those 13.15% of women to trial labour instead of scheduling their repeat sections, we could automatically reduce that number by 60% to 80%. I pulled out my calculator:
If 60% of women were successful at VBAC, our section rate would drop to 18.41%
If 80% of women were successful at VBAC, our section rate would drop to 15.78%
Other things we can do to reduce c-section rates? Normalize midwifery (my midwife’s c-section rate in 2008 was a mere 3%…though high risk deliveries are referred OUT of midwifery care and thus affect the intervention rates, low risk deliveries by general practitioner physicians are still in the 25% to 30% range, pointing towards midwives as the better way to go if the goal is a reduction in surgical rates). Discourage routine continuous external fetal monitoring for low risk deliveries. Encourage the usage of doulas (intervention rates are automatically reduced when a doula is present). Encourage upright, mobile labour, upright delivery positions, and water births. Never leave a woman in labour and her husband or partner alone unless the woman is confident and requests privacy. Never invade the privacy of a woman in labour without her express consent, since birth is a parasympathetic nervous system function which functions best with as relaxed and calm a state as possible. Any fight or flight fear response will suppress this natural parasympathetic process. I think being left alone in early labour creates more fear than any other routine procedure in birthing. Fear taps into the fight or flight, sympathetic nervous system response, which automatically slows or stalls the rest/regeneration/reproduction, parasympathetic nervous system response. Failure to progress can result. Inability to push out a baby can result. Piddly labour can result.
Privacy, yes. Isolation, no.
But I think fundamentally at fault is our cultural belief that birth is dangerous, and that womens’ bodies are unable to give birth. Somehow, birth seems impossible. Many women believe their bodies are broken, or weak, or too small, or incapable…these fears are normal when we are pregnant, but they are untrue. Unfounded. If we believed in women’s ability to give birth, and if we believed that birth was difficult but beautiful and valuable in and of itself much like other feats of physical strength and endurance, perhaps we would be able to lower those rates of surgical birth.
World Health Organization Maternal Health
International Cesarean Awareness Network, Canada and U.S.
BC College of Midwives
Society of Obstetricians and Gynecologists of Canada
Dr. Sears Pregnancy and Childbirth
Dr. Rixa Freeze Pregnancy and Birth Blog
Birth and Feminism by The Feminist Breeder