Risks and Benefits of Planning a C-Section

What is more natural than a vaginal delivery?  It is the accepted way of bringing a child into the world.  Not so many years ago a c-section delivery was only done if there were some sort of complication.  Indeed, women who ended up having a c-section where considered deprived in some way because she didn’t get to “do it right”.  Well, times have changed.

Some mothers are concerned that a c-section baby may not take to the breast as easily as one born vaginally.  Another worry is that the bonding processes will somehow be disturbed.  But neither is true.  All studies have shown that babies born vaginally and the ones born by c-section react to breastfeeding appropriately.  The bonding process happens over time.  Nevertheless, now days a c-section mother can hold her baby right after birth just the same as long as she communicates her wishes to the doctor.

The death rate for full term babies born vaginally is 2 in 1,000. Those numbers go up if the baby is 10 pounds or more, is in a breech position, or in the case of multiples.  In those cases it is more likely that forceps are used to get the baby out. Use of forceps can cause damage to the baby.  The main reason for this is that the trip through the birth canal can cause brain injury, it’s rare but it happens.

The medical world could really benefit from more thorough research on the subject of vaginal versus c-section delivery.  Many obstetricians feel it is their ethical obligation to talk women out of elective c-sections.  Others believe that women should be informed and choose for themselves.  Those who believe that c-sections should only be performed for medical reasons refer to the risks involved.  C-sections are major surgery which brings risks of infection, excessive bleeding, and painful recovery.  C-sections also mean risks in future pregnancies.  If the uterus ruptures, although it is rare, the life of the mother and the baby is in serious danger.  Babies born by c-sections have more breathing problems right after birth.

Physicians and other health care workers who support elective c-sections say that the surgery can protect a woman’s pelvic organs, reduces the risk to bowel and bladder, and is at least as safe for the baby as vaginal delivery.

In either case, child birth is going to be painful.  In vaginal deliveries, the pain of labor lasts hours and you just can’t know when it will end until the baby is actually born.  But, recovery is only slightly painful; in many cases it’s just uncomfortable.  In the case of c-sections, there is no unlimited time of painful labor but recovering from major surgery can be very painful.  Recovery can take up to 6 weeks.  If you are considering an elective c-section, you must find a doctor willing to do it and educated yourself to the pros and cons.  Only then can you feel confident in your choice.

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Prolonged labor may lead to the decision to perform a c-section. If labor has been intense and more lengthy than advisable, a physician may decide on surgery.

Dystocia is an abnormal or particularly difficult labor or childbirth.

Fetal distress is the presence of signs in a pregnant woman that that the fetus is not well or is becoming excessively fatigued. These symptoms may present either before or during childbirth.

Cord prolapse is when the umbilical cord precedes the fetus’ exit from the uterus.

Uterine rupture typically occurs during early labor, but may already be present during late pregnancy. The reliability of the middle layer of the uterine wall is breached.

Placental problems such as placenta praevia where the placental lining is separated from the uterus. Or, placenta accrete, an abnormal attachment of the placenta to the middle layer of the uterine wall.

Breech or traverse positions. Breech is when the baby enters the birth canal with the buttocks or feet first. Traverse position is sideways.

Failed induction of labor. When labor has been induced by various methods, but has failed to cause productive results.

Failed instrumental delivery. The use of forceps and other instruments.

Overly large baby. When the baby is just too big to fit through the birth canal.

Umbilical cord abnormalities.

Other complications of pregnancy and preexisting conditions include but not confined to:

• Pre-eclampsia
• Hypertension
• Multiple births
• High risk fetus
• HIV infection of the mother
• STDs
• Previous c-section
• Prior problems

There are many factors involved in the decision to perform a c-section. We have only touched on the more frequently presented ones. You should always consult with your physician if you any concerns and questions.

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Studies show that VBACs are more risky for the woman and baby than a repeat c-section. The most serious danger of VBAC is the chance that the c-section scar on the uterus will open up during labor or delivery. This is known as an uterine rupture. While extremely rare, uterine rupture is very dangerous for the mother and the baby. Less than 1 percent of VBAC lead to uterine rupture. Even so, uterine rupture can lead to life threatening bleeding for the mother and brain damage or even death for the baby.

In a study of over 30,000 pregnant women who had prior c-sections, 73% had successful VBACs. The remaining 27% tried to deliver vaginally, but ended up having another c-section. While rare, problems with the mother and the baby were more common in the VBACs compared with the repeat c-sections. Only 0.8% suffered a uterine rupture. Women who tried VBACs required more blood transfusions and a greater risk of endometriosis than those who had repeat c-sections. Babies born by VBAC had a higher risk of brain damage than those born by repeat c-sections.

The number of VBACs is dropping in the United States for a number of reasons. Doctors and hospitals are threatened by the number of possible lawsuits brought on by unsuccessful VBACs. Stiff guidelines are often imposed, requiring a standby surgical team be available during a VBAC. The expense and the risk, the health care workers construe, are just too high. Doctors are also discouraging or simply refusing to perform VBACs. Often this is because their affiliated hospital doesn’t allow them to. In other cases, doctors cannot get malpractice insurance to cover claims related to VBAC.

The decision to try VBAC is a serious one. Discuss the pros and cons with your physician and understand his/her level of confidence in the matter.

VBAC Considerations

Doctors may evaluate some of the following considerations when making the decision whether or not to go ahead with a VBAC:

• A women has had 1 previous planned c-section done with a low horizontal cut (bikini incision)
• A woman has no other uterine scars (aside from the prior c-section) or problems
• A woman has no known problems with her pelvis
• A doctor is present during all the labor and delivery and can perform an emergency c-section if needed
• An anesthesiologist and others of a surgical team are standing by in case an emergency c-section is required

The decision is not an easy one, nor should it be. The risk of a VBAC has its positives and negatives. Do your research and know yourself. Have serious conversations with your doctor, then make the decision for VBAC or not.

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Many experts think that up to one half of all c-sections are unnecessary. Thus, the U.S. government is trying to reduce that rate. Women need to be informed of the facts concerning c-sections before they deliver.

Types of C-Sections

An important distinction between the types of c-sections lies in the types of incision. The classical Cesarean section involves a midline longitudinal (up and down) incision which allows a larger space through which to deliver the baby. The incision runs from just under the mother’s belly button to just above the pubic hairline. However, it is rarely performed today because it is more prone to complications.

Most commonly used today is the lower uterine segment section. The incision is a traverse (running parallel above the pubic hairline) cut just above the edge of the bladder. With this procedure there is less blood loss and easier repair.

The emergency c-section is performed once labor has started.

A crash c-section is performed in an emergency, where complications present themselves suddenly during labor. In this instance, quick action needs to be taken to prevent the deaths of the mother and/or the baby.

A Cesarean hysterectomy includes the removal of the uterus. This may be due to stubborn bleeding or when the placenta cannot be separated from the uterus.

Porro’s Cesarean is a c-section followed by the removal of the uterus, ovaries, and oviducts. Or, a Porro-Muller c-section in which the uterus is lifted from the abdominal cavity before the fetus is extracted.

A repeat Cesarean is performed when a patient had a previous c-section.

Complications

Complications of labor and factors impeding vaginal delivery include:

• Prolonged labor or a failure to progress (dystocia)
• Fetal distress
• Cord prolapse
• Uterine rupture
• Placental problems (placenta praevia, placental (placenta lining has separated from the uterus), or placenta accrete (an abnormal attachment of the placenta to the middle layer of the uterine wall).
• Breech or transverse positions
• Failed induction of labor (induced labor)
• Failed instrumental delivery (use of forceps and other instruments)
• Overly large baby
• Umbilical cord abnormalities
• Contracted pelvis
• Pre-eclampsia (hypertension in association with high protein count in the urine)
• Hypertension
• Multiple births
• High risk fetus
• HIV infection of the mother
• Sexually transmitted diseases (STDs)
• Previous c-section

As you can see, there are many factors that can influence a physician’s decision to perform a c-section; not everything is cut and dry.The presentation of some of these complications will undoubtedly required a c-section, while some problems can be dealt with, allowing a vaginal delivery. Speak with your health care professional about any concerns you may have regarding c-sections.

Anesthesia

Both general (a state of total unconsciousness) and regional (body is totally numb, usually from breast bone through the legs) anesthesia are acceptable for use during a c-section. Regional anesthesia is preferred because it allows the mother to be awake and interact immediately with her baby. Regional anesthesia is less risky than general anesthesia. Regional anesthesia is used in 95% of c-section deliveries.

General anesthesia may be necessary because of specific risks to the mother or baby. Patients with heavy or uncontrolled bleeding may not tolerate the effects of regional anesthesia. General anesthesia is also preferred in very urgent cases, such as fetal distress, when there is no time to perform regional anesthesia.

Recovery

There’s just no way around it, giving birth is painful. In vaginal deliveries, some women experience long and dreadful labor. Some women sail through quickly with little more than cramps. It is the same with c-sections. For some, the very act of turning onto your side in your bed is excruciating. Some women sail through a c-section claiming it’s the only way to go. The fact is that a Cesarean section is major surgery and should be treated as such.

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