Friday, March 5, 2010

C-Sections: Not Something To Take Lightly

A recent article in Lancet, a leading medical journal out of England, cites a spike in cesarean sections (c-section) over the last decade. The greatest rise was seen in China, where this surgery was performed in 46% of all deliveries. In Chinese culture, this spike is tied to an increase in wealth, a perception of modernity, and even a desire to have your child born on a “lucky” birthday. However, this rise in c-sections can be seen across the entire globe and over every socioeconomic class. Even in the United States the rate of c-sections has risen from 4.5% back in 1965 to 33% in 2007.

There are many reasons why this rise is happening. Research suggests that the natural contractions of the uterus are disrupted by the continual electronic monitoring of the baby as well as by the administration of epidurals early in the delivery. Women are rarely being advised of all their birthing options, perhaps because as medicine becomes more advanced a more casual attitude towards major surgeries is taking hold. It is easier to “go in” and get the baby then invest the time and energy in having a doula or other trained professional present to assist in a natural birth. One is also left to wonder whether insurance compensation practices pressure doctors to deliver in an efficient manner, as a long, drawn out delivery is still reimbursed as just “a delivery”.

It is important to realize that c-sections pose a great deal of risk to both the mother and the child. Mothers will have uterine scarring after the c-section that increases the future chances of infertility, ectopic pregnancies and placenta previa, a condition where the placenta develops across the cervix, increasing the risk of miscarriage. A higher rate of unexplainable fetal demise happens after week 34, late in the 3rd trimester, in women who have scarred uteruses. And the one proposed benefit of a c-section, protecting the pelvic floor and reducing future incontinence, seems over emphasized. Minimal differences exist 6 months postpartum and by age 50 no noticeable difference in the strength and function of the pelvic floor is detectable. Furthermore, this concern can be offset by regularly practicing simple pelvic floor exercises.

Babies, too, are put at risk when a c-section is performed. A recent study has shown that the normal infant mortality rate in the United States, 0.62 deaths per 1000 vaginal births, jumps 3 fold to 1.77 deaths per 1000 when a c-section is performed. While this is still considerably low, it is cause for concern. These deaths can be the result of something as simple as being cut during the procedure or as complicated as developing dyspnea, a breathing disorder, after they are born. Dyspnea can develop in weaker children who are unable to clear out the amniotic fluid in their lungs that would normally be pushed out by the natural physical compression of the lungs during vaginal birth. Children delivered via c-section have high levels of pain medicines in their systems, leaving them sleepy and uninterested in breastfeeding. These children often lose interest in breast-feeding and again if already weakened, can fail to thrive.

Cesarean sections are one example of the great strides modern medicine has made to save lives and avert emergencies. However, this is a major surgery that does come with serious risks, and anyone planning a family should evaluate the pros and cons prior to their delivery date.

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