Across the nation about 30% of deliveries are done by caesarean section (c-section). Most c-sections are performed at the recommendation of an obstetrician, but in recent years, more women have asked to be delivered by caesarean and have optedout of labor.
Women request the surgery for a many reasons including a previous painful or traumatic birth experience or tales about the “horrors” of a vaginal delivery. Often though, when asked why they want a c-section, the answer is some variation of…“I don’t want to go through all that…I just want a c-section.”
There is no such thing as just a c-section. Although, the rate of complication from this surgery is extremely low, it’s still considered a major abdominal operation and patients have become overly nonchalant about it.
Delivery by surgery can benefit the baby in that they have fewer birth injuries and infections. However, babies born by c-section have the highest rate of breathing problems and often need assistance from neonatologists. They also have higher rates of hypoglycemia (low blood sugar) at birth. The passage through the birth canal helps clear the lungs and allows the baby time to correct glucose abnormalities.
For the mother, there’s a lower for hemorrhage risk with a c-section. And, women who have c-sections have fewer problems with urinary incontinence (leaking of urine), but only for the first year after delivery.
On the flip side, it’s important to consider the total number of c-sections that a woman undergoes. A bikini cut may look better, but it still extends into the abdomen and significant scarring can occur underneath the skin. Scar tissue also forms on the uterus and can cause the placenta to attach abnormally in subsequent pregnancies. These patients often end up needing a c-section and a hysterectomy. In addition, if the scar on the uterus separates, the baby will have to be delivered—sometimes prematurely—by an emergent c-section, which further increases the injury risk for the mother.
Consider also that c-sections do not always “save” the vagina. Studies have shown that c-sections do not necessarily keep the uterus from dropping into the vagina (known as uterine prolapse). However, to decrease this risk, I would advise women to limit weight gain. This limits the size of the baby and reduces trauma to the vagina.
I will admit, if a woman experienced a vaginal delivery where she had a horrendous tear down into the rectum, I would advise her to have a c-section for the next delivery. Urinary incontinence is one thing to worry about, but fecal incontinence is quite another, and no woman should have to face that.
Overall, women who leave the hospital with healthy babies are happy, regardless of how they were delivered.
But before you elect to just have a c-section, think carefully about the consequences. If you are planning to have more than one or two babies, the drawbacks of having a multiple surgeries start to outweigh the benefits.
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