What are the benefits and risks of elective cesarean section?
Safe Birth Practices Editorial
Erika Harding, Doula and Childbirth Educator
former owner of Body, Mind & Spirit Childbirth and Family Resource Center
Women giving birth in Albuquerque are lucky. We have many options that other women around the country and even around the state don’t have, and in general we have a relatively humane birthing and maternity care system. I could cite many examples of this, but I’ll limit myself to one anecdote: as a Doula, or professional labor support person, here in Albuquerque I have attended about 90 births, the majority in hospitals. Out of these 100+ births, I have only once seen a doctor or midwife perform an episiotomy on a birthing mother. In contrast, I have a friend who is a Doula in Boulder, Colorado. My friend has attended 10 hospital births in Boulder, and each and every one of those women had her perineum cut by her doctor. In spite of Boulder’s reputation as a progressive town, they do not have midwives attending births in the hospitals, as we do here. The presence of midwives delivering babies in both hospital and out-of-hospital settings has a tremendous influence on obstetrical practice. In New Mexico, home birth is legal, state licensed and regulated, and widely practiced. In Albuquerque, we have three hospitals that offer the Midwife Model of Care, an advantage we have over Santa Fe, where no Certified Nurse Midwives have been allowed to practice at the one maternity hospital, St. Vincent’s. Our hospitals are large enough to offer high-level emergency medicine when needed by mothers and babies, and there are still doctors and midwives in Albuquerque who offer mothers who have experienced a previous cesarean birth the chance to birth their subsequent children vaginally. In addition, we have a large community of professional Doulas, and one hospital even employs Doulas on staff.
This is all to our advantage. However, Albuquerque and the country at large tands to take a major step back in maternal health as a consequence of a position taken by the American College of Obstetrician Gynecologists, or ACOG, the primary association of ObGyns in the country. ACOG regularly makes policy statements which have a powerful effect on obstetrical practice around the country. On October 31 of 2003, ACOG released a statement declaring as ethical” the practice of offering a healthy woman pregnant with her first baby the option of scheduling an elective cesarean. Let me repeat. ACOG is opening the door for what they call a “shift in clinical practice,” allowing doctors to perform major abdominal surgery on healthy women without any medical ustification.
Does this surprise you? It certainly surprised me. I felt that it must be based on research, some evidence that shows that women or babies benefit fromcesarean birth, whether or not they have risk factors or complications. Strangely, no. About 36 of 100,000 women die in cesarean sections, compared to 9.2 per 100,000 for vaginal birth. In addition to the increased risk of dying, other risks to mothers include wound and uterine infection, hemorrhage, ureter injury, injury to bowels, urinary tract infection, thromboembolic conditions and incisional endometriosis. Their future births are also affected by a cesarean, which increases the likelihood of placenta previa, placental abruption, ectopic pregnancy, placenta accreta and uterine rupture. In addition, women who have their first baby by cesarean section are at higher risk of losing their next baby to an unexplained stillbirth before going into labor.
Ok, so elective (not medically necessary) cesareans are not a good thing for women and their future babies. How about for the baby? Babies delivered by elective cesarean section are cut during surgery 2-6% of the time, have a 9% chance of being born prematurely, and risk a 0.2-1.7% chance of developing respiratory distress syndrome, a potentially fatal complication. They spend more time in neonatal intensive care units and have more breastfeeding difficulties than babies born vaginally.
This is made even more clear by the following. We have a trust that our medical system is one of the best in the world, and that mothers and babies are lucky to birth in America, right? As of 1999 (the most recent data available), the US ranked 21st in the world for maternal mortality, and 28th among industrialized nations in infant mortality as of 1998, behind both the Czech Republic and Cuba. In spite of the tremendous financial resources we spend on maternal and infant health, our country loses a remarkable number of mothers and babies.