British Columbia has the highest rate of Cesarean Sections, (C-sections), in Canada. According to figures released by the Canadian Institute for Health Information, B.C.’s overall caesarean rate is reaching 35 percent; this compares with 28 percent nationally. Around the world, rates of C-sections are soaring. Approximately one in three births is via C-section. That rate has increased from about 5 percent in 1970 to 20 percent in 1996 to the current 32 percent. These statistics might suggest that one-third of all pregnant women are now inexplicably having complications that require a cesarean; however, that would be an inaccurate conclusion. Judicially medically indicated causes are not the reason that so many women require major abdominal surgery for what should be a normal physiological process.
When medically indicated, such as in placenta previa, fetal distress, or abnormal positioning, caesarean sections save the lives of women and babies. In some cases, C-sections are planned for medical reasons that make a vaginal birth too risky. Sometimes C-sections are unplanned, and are done for emergency reasons because the health of the mother, the baby, or both are in jeopardy. However, many women are opting to have an elective C-sections for non-medical reasons. In some countries, it has become fashionable and considered “modern” to deliver without labour. This thinking has sometimes been derogatorily referred to as being “too posh to push”.
Internationally known contributor to the 2018 Lancet series on cesarean sections, midwifery researcher and professor at Yale, Holly Powell Kennedy, PhD, CNM, FACNM, FAAN notes, “Interestingly enough, women that have greater education are more likely to have a cesarean, which is a bit of a paradox in itself because a cesarean is not a low risk surgery. It’s major surgery and there are small but serious risks—with the immediate surgery, and then later in terms of the scar and stillbirth in preterm birth with subsequent pregnancies. And that’s one small piece of the puzzle…”
Furthermore, it isn’t only the mothers who are asking to schedule elective C-sections. Often, doctors are suggesting C-sections for reasons of their own. Some doctors do not recommend a vaginal birth after a prior C-section. Other practitioners prefer the predictable nature of a C-section to optimize scheduling and time management. And, in some countries, doctors and hospitals earn more money when a child is delivered via C-section rather than vaginally.
While experts agree that Cesarean deliveries can be life-saving when they are medically necessary, many question the practice of scheduling C-sections for non-medical reasons. Dr. Neil S. Seligman, an OB-GYN at the University of Rochester Medical Center in New York points out, “There is an exaggerated perception of the safety of Cesarean section to [an] extent that is viewed as essentially risk-free. But it is major abdominal surgery and complications are going to happen. Complications are a reality that can have a significant impact, among other things, interfering with breastfeeding, bonding with the baby, and can spark postpartum depression.” He went on to say, “Once you put a hole in the uterus there’s no going back. It will always be an issue that needs to be addressed in future pregnancies so it’s essential that the decision to pick up a knife is a well thought out one by both the physician and the patient.”
Let’s take an objective view of some of the benefits and risks of having a C-section.
Benefits for the Mother:
Some women choose to have a C-section when she has had a previous complicated or traumatic vaginal delivery.
Some women choose to have a C-section if she has a fear of of giving birth vaginally.
Some women choose to have a C-section to avoid tearing or stretching of the vaginal tissues and trauma to the pelvic floor. Women who have had a caesarean were less likely to develop urinary incontinence (9%) than those who had a vaginal delivery (15%) There is also a lower chance of pelvic organ prolapse after caesarean delivery (5.6%) versus in vaginal delivery (6%)
Some women may also choose to have a C-section when she prefers the convenience and control of being able to plan the precise timing of her birth.
Benefits for the Baby:
C-sections lower the risk of birth injuries such as asphyxia (oxygen deprivation), shoulder dystocia, and fractures.
Risks to the Mother:
In terms of physical risks, C-sections carry risks of infection, bleeding, clotting and reactions to anesthetics. Recovery from a C-section is longer and a woman who has a C-section typically stays in the hospital longer- two to four days versus 24-48 on average for vaginal deliveries
Once a woman has had her first C-section, she is more likely to have a C-section in her future deliveries. She may also be at greater risk of future pregnancy complications, such as placental abnormalities and uterine rupture,
Emotionally, a major new study, from the University of York, provides evidence that first-time mothers who give birth via unplanned caesarean section are 15% more likely to experience postnatal depression. Some women express dissatisfaction with the delivery experience or process and mourn the loss of the opportunity to deliver vaginally. Some women may even initially experience difficulty bonding with the baby.
Risks to the Baby:
Babies born by Caesarean section are more likely to have breathing problems at birth and even during childhood, such as asthma. (21% increased risk)
For reasons that remain unclear, some studies have also suggested a link between babies delivered by C-section and a greater risk of becoming obese as children and as adults. (59% increased risk). One theory is that the baby isn’t exposed to bacteria in the mother’s vagina. This bacteria is called the microbiome, and it is found in the guts of babies who have been born vaginally and may help protect against asthma and obesity during childhood.
It could also be linked to the fact that women who have a C-section are more likely to have problems with establishing breastfeeding, which protects against obesity in the baby and promotes a long-term healthy immune system
For more in depth information on the effects of having a C-section on the development or your baby’s microbiome read: Your Baby’s Microbiome written by the Toni Harman and Alex Wakeford the award winning directors of the documentary MICROBIRTH, a film exploring the latest science about why vaginal birth and breastfeeding is so critical for a baby’s lifelong health.
Saraswathi Vedam, an associate professor of midwifery at the University of British Columbia, says she and her colleagues are “troubled” by the continuing rise of C-sections. Vedam attributes much of the increased use of C-sections to a lack of information. “Patients often don’t have a lot of support or awareness about birth as they go into labour, so they might not know what’s normal or how long it should take, which can make them more likely to choose a Caesarian. They might also not fully understand the long-term health implications of a Caesarian birth, compared to slightly elevated risks of complications with a vaginal birth.”
So, bottom line…A caesarean section can be a life-saving intervention when medically indicated, but this procedure can also lead to serious short and long term health effects for women and children and should be very carefully considered.