Is A C-Section Birth Worth the Recovery Time?
A family doctor friend of mine recently asked me what percentage of my patients deliver via C-section versus vaginal delivery. Off the top of my head I thought 30-40%, though I had never thought it through before. Since she asked, I have been paying attention, and my guess was right on. Each month varies, but some months about half of my newborns are delivered via C-section.
This is HIGH. In Canada and the United States, emergency and elective C section rates are steadily growing, and in some States, more babies are born via surgical delivery than natural. The C-section rate across the UK is over 25%, and in the US and Canada >30%! This is NOT NORMAL. Sure, some babies are just not going to come out the traditional way. Mom’s body and baby’s body do not always jive. Luckily, we have the means to enable a healthy, successful delivery of a baby like this. This is not the case around the world when many babies and moms suffer severe injury or death during labour. C-section is a blessing in these circumstances, but surely, this can’t be the norm.
So why are more babies being delivered via C-section?
- Women are having babies at older ages.
- Women are heavier, and having larger babies, making traumatic vaginal birth more likely. The same goes for moms with gestational diabetes, where C-section may be planned without even trying natural labour.
- Moms with multiples are more likely to have fetal growth restriction, premature delivery and complications leading to C-section.
- Vaginal breech deliveries are no longer routinely recommended. There is a small risk of injury to a breech newborn born vaginally. Parents and docs are nervous about this, and as a result fewer doctors are trained for vaginal breech delivery and most breech babies are now delivered with C-sections.
- Fewer attempts at vaginal delivery after C-sections. In this instance there is a small, but real risk of rupture in the previous scar in the uterus. Because of this risk many moms and physicians opt for a C-section over vaginal birth.
- More induced labors. We now monitor baby so well at the end of pregnancy that lowered fluid levels, decreased growth velocity or decreased movement is readily apparent. When women and docs get worried about how baby is doing, we bring them out faster with induction.
- Of course, there’s the issue of convenience. Parents want to know when to leave their job, when to show up for delivery and when to arrange child-care. If you are like me, the doc that followed you through pregnancy will want to deliver you, which requires planning and less spontaneity. As a result, more moms are being induced. The longer and artificial labour often results in a C-section
- Fetal monitoring tells us if baby is compromised during labor. If changes are noted that could indicate fetal distress, rapid delivery by C-section is often performed. Interestingly, fetal monitoring, per se, has not changed perinatal mortality rates and often the babies that appear compromised during monitoring are born with robust breathing, movement, and heart rates and no underlying distress. But, I wouldn’t want to take that chance, would you?
- Fear of pain. Some women feel that if they have a cesarean delivery they will have epidural anesthesia throughout the procedure without the potential of having to deal with labour and delivery pains. If you think this, you haven’t had a C-Section. The healing is often harder and longer.
So, is C-section a better choice?
In an emergency situation, no one will argue to wait and try a vaginal delivery. But for the majority of cases when it is not life-or-death, should babies be born via C-section? I argue no. For moms, there can be injury to organs adjacent to the enlarged uterus, including the bowel, bladder, blood vessels. There is also an increased risk of infection at the cesarean scar site or under the skin, development of blood clots and pulmonary embolism. C-Section recovery time tends to be longer than from vaginal birth. There is an increase in the risk of re-hospitalization which is double that of vaginal deliveries. For babies, there is a higher risk of respiratory distress and need for resuscitation.
At the end of the day, the way your baby is delivered is a personal choice. I simply want you to make an educated one that you make in consultation with your doctor or midwife.
How did your little ones enter this world? Would you do it differently?
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