Caesarean births have been on the rise. Is this really best for you and for your baby? Have you considered more natural options available to you?
Here are some factors that are influencing the rise of our Nation’s “Cesarean method:”
- Low priority of enhancing women’s own abilities to give birth – Care that supports physiologic labor, such as providing continuous support during labor through a doula or other companion and using hands-to-belly movements to turn a breech (buttocks- or feet-first) baby to a head-first position, reduces the likelihood of a cesarean section.
- Side effects of common labor interventions – Current research suggests that some labor interventions make a c-section more likely. For example, labor induction among first-time mothers when the cervix is not soft and ready to open appears to increase the likelihood of cesarean birth. Continuous electronic fetal monitoring has been associated with greater likelihood of a cesarean. Having an epidural early in labor or without a high-dose boost of synthetic oxytocin (“Pitocin”) seems to increase the likelihood of a c-section.
- Refusal to offer the informed choice of vaginal birth – Many health professionals and/or hospitals are unwilling to offer the informed choice of vaginal birth to women in certain circumstances. The Listening to Mothers survey found that many women with a previous cesarean would have liked the option of a vaginal birth after cesarean (VBAC) but did not have it because health professionals and/or hospitals were unwilling (Declercq et al. 2006a). Nine out of ten women with a previous cesarean section are having repeat cesareans in the current environment. Similarly, few women with a fetus in a breech position have the option to plan a vaginal birth.
- Casual attitudes about surgery and cesarean sections in particular – Our society is more tolerant than ever of surgical procedures, even when not medically needed. This is reflected in the comfort level that many health professionals, insurance plans, hospital administrators and women themselves have with cesarean trends.
- Limited awareness of harms that are more likely with cesarean section – Cesarean section is a major surgical procedure that increases the likelihood of many types of harm for mothers and babies in comparison with vaginal birth. Short-term harms for mothers include increased risk of infection, surgical injury, blood clots, emergency hysterectomy, intense and longer-lasting pain, going back into the hospital and poor overall functioning.Babies born by cesarean section are more likely to have surgical cuts, breathing problems, difficulty getting breastfeeding going, and asthma in childhood and beyond. Perhaps due to the common surgical side effect of “adhesion” formation, cesarean mothers are more likely to have ongoing pelvic pain, to experience bowel blockage, to be injured during future surgery, and to have future infertility. Of special concern after cesarean are various serious conditions for mothers and babies that are more likely in future pregnancies, including ectopic pregnancy, placenta previa, placenta accreta, placental abruption, and uterine rupture .
- Providers’ fears of malpractice claims and lawsuits – Given the way that our legal, liability insurance, and health insurance systems work, caregivers may feel that performing a cesarean reduces their risk of being sued or losing a lawsuit, even when vaginal birth is optimal care.
- Incentives to practice in a manner that is efficient for providers – Many health professionals are feeling squeezed by tightened payments for services and increasing practice expenses. The flat “global fee” method of paying for childbirth does not provide any extra pay for providers who patiently support a longer vaginal birth. Some payment schedules pay more for cesarean than vaginal birth. A planned cesarean section is an especially efficient way for professionals to organize hospital work, office work and personal life. Average hospital charges are much greater for cesarean than vaginal birth, and may offer hospitals greater scope for profit.
Outside the realms of medical necessity, women have been giving birth naturally since the dawn of (wo)man. Now I can not be certain since I was not there but I am pretty sure Biblical Eve did not have any medical intervention. Just like I tell my patients, I will blog this: “Our bodies are not faulty by design, so we need to give it more credit where credit is due”.
Moms-to-Be: You carry, eat, sleep, think and feel your baby – you know your baby and you know what it needs. So why let someone who does not have that intimate connection, that special bond, tell you when, where and how you should deliver.