The World Health Organization recommends that the rate of C-sections performed for medical reasons should be between 10 and 15 percent. Many medical experts believe that represents the approximate percentage of births that justify a C-section for the safety of either mother or child. But in some countries the percentage of C-sections is double and even triple that figure.
In the United States the rate hovers around 30 percent, five times the rate in 1970. Common reasons for a C-section include:
- a complication such as fetal distress;
- the infant being in a breech position;
- failure of labor to progress;
- a multiple birth;
- the mother having had a previous C-section;
- the mother with an active genital herpes infection or who is HIV positive (cesarean delivery prior to labor lowers the chances of HIV transmission to the infant);
- scheduling of an induced labor prior to the actual due date;
- convenience for mothers;
- defensive medicine in response to a litigious environment.
The United Kingdom and Canada have seen rates of C-sections rise from 17 percent in the mid 1990s to 24 percent in 2003. In some areas of China rates are reported to be as high as 50 percent of all births.
One of the reasons for the rise in C-section rates is that a woman who has had a C-section is likely to have another with a subsequent delivery. Although it is possible (and even recommended) to attempt a vaginal birth after a C-section (VBAC), it is becoming increasingly less common.
The major risk for VBAC is the possibility of a rupture at the site of the old C-section scar. If that happens, an emergency C-section is then necessary. This complication arises in only 1 percent of VBAC cases, however.
One British study that provided computer-based information to pregnant women who had previously had a C-section found that women who used the decision aids were more likely to opt for a vaginal birth, had greater knowledge and lower levels of anxiety than a control group. The model provided a greater opportunity for the women to be more involved in the decision-making process.
Recent studies have raised concerns about the health of both mother and child after elective C-sections. One study [British Medical Journal, December 12, 2007] reported that infants delivered by elective C-section at 37 weeks had four times the rate of respiratory problems compared with infants born by vaginal delivery. Doctors aren’t sure why but speculate that the increased risk may have to do with hormonal and physiological changes that occur naturally during labor that contribute to maturation of the infant’s lungs.
Another study found that women who had C-sections faced twice the risk of hysterectomy, blood transfusion, admission to intensive care and even of death compared with women who had vaginal deliveries.
This increased risk for women having C-sections did not hold true for women whose babies were in the breech position. For those women, the benefits of a C-section outweighed any added risk.
A C-section typically takes about an hour. The pregnant woman can discuss the type of anesthesia she would prefer; in many cases a spinal anesthetic is administered which allows the woman to remain awake and experience the birth of her child.
A screen prevents the woman from seeing the surgical procedure, but it can be lowered a little so she can see her child being lifted from her womb. The infant is delivered in the first five to fifteen minutes, and the rest of the surgery involves closing the abdominal layers.
The baby can often be with the mother during recovery, and mothers who plan to breast feed are encouraged to attempt nursing their child at this time.
Childbirth is a major milestone in the life of a woman. The decision on the best and safest option for the woman and her infant is a significant one that should be made for medical and individual reasons.
Michelle Herbert Thomas, PharmD, CDE—Rev. 5/19/2010 TNK
