Avoid A Cesarean: Know The Facts

These facts are presented by the International Cesarean Awareness Network with the hope that parents, childbirth educators, doulas, nurses, midwives and doctors together can effectively reduce the rate of unnecessary cesarean sections and their effects.

A cesarean section is major abdominal surgery used for the delivery of an infant through an incision in the mother’s abdomen and uterus. The incision may be made across the bottom of the abdomen above the pubic area (transverse) or in rare instances, in a line from the belly button to the pubic area (vertical).

Many reasons given for a cesarean, especially prior to labor, can and should be questioned. These include macrosomia (large baby), maternal age and parity, assisted reproductive technology, CPD, dystocia, failure to progress, breech, fetal distress and even prolonged second stage. There are very few true indications for a cesarean section in which the risks of surgery will outweigh the risks of vaginal birth.

When a cesarean is necessary, it can be a lifesaving procedure for both mother and baby. However, psychological outcomes such as negative feelings, fear, guilt, anger and postpartum depression are common consequences of both emergent and elective cesarean sections. A cesarean section is only indicated in the following situations:

• complete placenta previa at term

• transverse lie at complete dilation

• prolapsed cord

• abrupted placenta

• eclampsia or HELLP with failed induction of labor

• large uterine tumor that blocks the cervix at complete dilation (most fibroids will move upwards as the cervix opens, moving it out of baby’s path).

• true fetal distress, confirmed with a fetal scalp sampling or biophysical profile

• true absolute cephalopelvic disproportion or CPD (baby too large for pelvis). This is extremely rare and only associated with a pelvic deformity (or an incorrectly healed pelvic break). Fetal positioning during labor and maternal positioning during second stage, most notably when women are in a semi-sitting position, cause most CPD diagnosed in current obstetrics.

• initial outbreak of active herpes at the onset of labor

• uterine rupture

The cesarean-section rate remains alarmingly higher in many industrialized countries than the 10 to 15 percent average recommended by the World Health Organization, causing unnecessary risk to both mother and baby. Healthy People 2010, a health promotion program managed by the U.S. Department of Health and Human Services, recommends a reduction in cesarean births in the US to 15 percent by 2010.

A cesarean poses documented medical risks to the mother’s health. These risks include infection, blood loss and hemorrhage, hysterectomy, transfusions, bladder and bowel injury, incisional endometriosis, heart and lung complications, blood clots in the legs, anesthesia complications and rehospitalization due to surgical complications. Rate of establishment and ongoing breastfeeding is reduced, psychological well-being is compromised and there is an increased rate of emotional trauma. Potential chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sexual intercourse. Scar tissue makes subsequent cesareans more difficult to perform, increasing the risk of injury to other organs and the risk of chronic problems from adhesions. One half of all women who have undergone a cesarean section suffer complications, and the mortality rate is at least two to four times that of women with vaginal births. Approximately 180 women die annually in the United States from elective repeat cesareans alone.

The risk to your infant from the very low incidence of uterine rupture (less than 1 percent) after a prior cesarean is much less than the risk to your infant from respiratory distress as a result of a scheduled cesarean.

Vaginal Birth After Cesarean (VBAC) is safer for both mother and infant, in most cases, than is routine elective cesarean, which is major surgery.

A cesarean poses documented medical risks to the baby’s health. These risks include respiratory distress syndrome (RDS), iatrogenic prematurity (when surgery is performed because of an error in determining the due date), persistent pulmonary hypertension (PPH), and surgeryrelated fetal injuries such as lacerations. Preliminary studies also have found cesarean delivery significantly alters the capability of cord blood mononuclear cells (CBMC) to produce cytokines. An elective cesarean section significantly increases the risk to the infant of premature birth and respiratory distress syndrome, both of which are associated with multiple complications, intensive care and burdensome financial cost. Even with mature babies, the absence of labor increases the risk of breathing problems and other complications. Far from doing better, even premature and at-risk babies born by cesarean fare worse than those born vaginally.

Each successive cesarean greatly increases the risk of developing placenta previa, placenta accreta and placental abruption in subsequent pregnancies. These complications pose life-threatening risks to mother and baby. Cesareans also increase the odds of secondary infertility, miscarriage and ectopic pregnancy in subsequent pregnancies.

Cesarean rates are influenced by nonmedical factors. These include: individual philosophy and training, convenience of doctor or patient, the patient’s socioeconomic status, peer pressure, fear of litigation and financial gain.

Cesareans can delay the opportunity for early mother-newborn interaction, breastfeeding and the establishment of family bonds.

In the United States, obstetricians offer defensive medicine as an excuse for the astronomical and sharply rising U.S. cesarean rate. Deliberately performing unnecessary surgery in the belief it avoids lawsuits is indefensible. That many obstetricians seem oblivious to this profound violation of ethical principles is shocking.

This fact sheet was provided by the International Cesarean Awareness Network (ICAN) and reprinted with permission. Founded as Cesarean Prevention Movement in 1982, ICAN has chapters, individuals, an international newsletter (the Clarion), an e-mail line and a website ready to give you support and information. For more information, please call 1-800-686-ICAN or visit ican-online.org