Latest News


RSS Feed
ELECTIVE CAESAREAN SECTIONS
ELECTIVE CAESAREAN SECTIONS
BY ELIZABETH CASE, M.D.
 
 
 
Over the past three decades, the number of babies born by Caesarean section has increased. In 2004, 29.1 percent of all babies were born by Caesarean section. Although some of the increase has been due to the decline in vaginal birth after Caesarean section, some of the increase has been due to elective primary C-sections. There are many medical indications for C-section, including specifi c medical conditions that put baby and/or mom at risk. However, many women are choosing to have a primary C-section with no medical indication.
 
There are many reasons why a woman might choose an elective C-section. First, some women choose Caesarean birth because they fear the pain associated with childbirth and a vaginal delivery. Other women choose this option to have more control over their delivery. Some choose an elective primary C-section to eliminate the possibility of damage to the pelvic floor that could result in urinary incontinence or sexual dysfunction.
 
In this article, I’d like to address the pros and cons of vaginal delivery versus Caesarean delivery. There are many arguments supporting delivery via the birth canal, also known as vaginal delivery. First, there is less risk of maternal blood loss, infection, blood clots and damage to organs. For the baby, there is less risk of breathing and blood pressure difficulties at birth. Babies born vaginally also have less risk of allergies, asthma and lactose intolerance. After a vaginal delivery, there is a shorter hospital stay, and breast feeding is more effective. But there are also cons to vaginal delivery. These include an increased risk of oxygen deprivation from cord compression or complications during delivery. There is an increased risk oftearing of the perineum (area between the vagina and the rectum) resulting in the need for stitches. This can lead (rarely) to an increased risk of sexual dysfunction in the first three months following delivery. There can be an increased risk of trauma to the baby if a vacuum or forceps are required for delivery. Finally, there is the pain associated with childbirth and also the discomfort from repeated vaginal exams, which can be intolerable for some women who have experienced sexual abuse in the past.
 
Some of the pros for elective Caesarean section include an increased sense of control as a woman can choose the timing and date of her delivery. There is also a decrease in the stress associated with the anticipation of labor. Some studies show a decreased risk of oxygen deprivation to the baby and possibly decreased risk of trauma associated with the need for a vacuum or forceps assisted delivery. Since there is no tearing of the perineum, there is a decreased risk of urinary incontinence and sexual dysfunction in the first three months after delivery.
 
The cons include a longer hospital stay. There is a higher incidence of blood clots and infections and an increase in the maternal blood loss. There is a rare risk of damage to the baby while making the uterine incision. There is a rare risk of complications from anesthesia (but these same risks can be associated with vaginal deliveries if anesthesia is used). The patient is also at increased risk of damage to the bowel and bladder during the procedure and a slower return of bowel function.
With an elective primary Ceasarean section there is a delay in maternal breast milk production, which can hinder breast feeding. The maternal mortality rate is slightly higher as well. There is also a risk of lower Apgar scores for babies (the score given to the baby as soon as it is born to evaluate the newborn’s physical condition and to determine any immediate need for extra medical or emergency care) and twice the infant mortality (in the first 12 months of life) for babies born by Caesarean section
 
In subsequent pregnancies, there is an increased risk to the mother, whether she delivers the baby traditionally through the birth canal (also known as vaginal birth after Caesarean or VBAC) or by C-section.
 
In 2003, the American Congress of Obstetricians and Gynecologists came forward with a Committee Opinion stating that: Obstetricians and their patients should make the decision for elective primary Caesarean section based on the individual and circumstances, and that there is no right answer to the debate.
 
This has opened the door for patients and physicians to make the decision for or against primary elective Caesarean section based upon each patient’s unique circumstances.
Originally Published on Wednesday, October 24, 2012