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Elective C-Section – Would You Do It?
It’s the latest thing. As fashionable as Kabbalah, without all the studying. Madonna did it. So did Elizabeth Hurley. Cesarean section by choice has become almost a kind of fad. Do Yoga at 8am Have your baby at 10am. It not only fits your schedule, but your doctors and you get the added benefit of avoiding anything remotely like labor pain.
Sandy, 34, had an elective C-section and often encourages other women to do the same.
“It’s so exciting to finally hear other women and members of the obstetrics community say what I’ve been saying for the last six years,” she said. “I had an elective C-section with my first pregnancy because I had a wonderful female OB who respected my desire to avoid vaginal and pelvic floor trauma. My C-section was amazing – wide awake and no pain, I was walking in less than 8 hours.”
Differing attitudes among doctors and mothers about the “right” way to deliver a baby not only cause confusion for new mothers who fear their first labor and childbirth experience, but division among feminists. For many years feminists have fought for the right to take control of their bodies again and to give birth to babies naturally without the unnecessary medical intervention that women were subjected to for much of the twentieth century. Now, a new generation of feminists is claiming that it is also their right to choose to deliver their baby without pain. But how safe is an elective caesarean section?
Some studies and doctors claim that elective cesarean is as safe if not more so than vaginal delivery and that the potential side effects of vaginal delivery make cesarean even more attractive.
Dr. Jennifer Berman, a urologist, author and television personality, said she chose to have a C-section with her second child and wished she had done so with her first.
“I had a very difficult time with the birth of my son, Max in December 1999. I was in labor for 18 hours, which was made more difficult by the fact that I had an epidural too early, which in turn caused the birth process to slow down.
“Max was supposed to be a seven-pound baby, but was actually nine pounds, eight ounces. His head and shoulders got stuck in the birth canal and he was in fetal distress. Given my body habit, he should have been delivered by c-section, but I persevered and delivered vaginally
“My second reason for choosing a c-section stems from the work I did as a urologist. During a reconstructive surgery fellowship last year, I saw women who suffered the effects of incontinence and prolapse. These effects are directly related to vaginal delivery.
“In cases where women are predisposed to incontinence and prolapse, doctors are willing to perform a c-section. I experienced incontinence for seven months after giving birth to Max and it started recurring during this pregnancy.
“If I had seen patients with such problems before Max was born, I would have also chosen to have a cesarean section with him. I decided that I did not want to risk more incontinence or prolapse in the future.”
A study conducted by HP Dietz, MD (Heidelberg) and MJ Bennett, MD (UCT) and published in the August 2003 issue of Obstetrics and Gynecology, the journal of the American College of Obstetricians and Gynecologists, concluded that: Vaginal birth, especially operative delivery, negatively affects pelvic organ support. This appears to be true for all three vaginal divisions. All forms of cesarean delivery were associated with relatively less pelvic organ progeny. These findings may partially explain the protective effect of elective cesarean delivery for future symptoms of pelvic floor disorders.”
Dietz and Bennett studied a total of 200 women, recruited early in their first pregnancy, and examined them during the first and early second trimester, the late third trimester and between two and five months postpartum. A total of 169 women or 84.5 percent showed very significant increases in organ mobility. In addition, the length of the second stage of labor correlated with an increase in pelvic organ prolapse, suggesting that vaginal delivery is a major contributor to pelvic organ prolapse.
However, what many defenders of an elective caesarean section do not mention is the fact that the same study also states that the most serious damage to the pelvic floor occurred in women who underwent an operative vaginal delivery. In particular, women whose babies were delivered with the help of forceps or vacuum extraction experienced the highest degree of damage. In addition, Dr. W. Benson Harer, Jr., president of the American College of Obstetricians and Gynecologists, supporting that every woman should have the right to choose between cesarean section and vaginal delivery, also admits that many pelvic floor problems. (urinary incontinence, uterine and bladder prolapse) can be prevented by improved labor and delivery techniques.
Episiotomies are also associated with pelvic floor damage and long-term complications. They have been shown to be unnecessary and harmful in most births, yet the majority of American women are still subjected to this surgical procedure during a vaginal birth.
The belief that a caesarean section is much safer for the baby is also controversial. In fact, the risks for the baby can be great. Caesarean section is a major surgery and carries many risks to mother and child. Babies born by caesarean section do not get the natural stimulation that comes from moving down the birth canal, and therefore often need to be given oxygen or rub down to help them breathe. They also miss the natural hormones that are released during vaginal birth to help the baby during its first moments of life.
According to the Mayo Clinic’s Complete Book of Pregnancy and Baby’s First Year the risks of cesarean section are great for mother and child:
1. Premature birth. If the due date was not calculated accurately, the baby could be born too early.
2. Breathing problems. Babies born by caesarean section are more likely to develop breathing problems such as transient tachypnea [abnormally fast breathing during the first few days after birth].
3. Low Apgar scores. Babies born by cesarean sometimes have low Apgar scores. The low score may be an effect of the anesthesia and caesarean birth, or the baby may have been in distress to begin with. Or perhaps the baby was not stimulated as he or she would have been through a vaginal birth.
4. Fetal injury. Although rare, the surgeon may accidentally cut the baby while making the uterine incision.
Risks to the mother are more common and include:
* 1. Infection. The uterus or nearby pelvic organs such as the bladder or kidneys can become infected.
* 2. Increased blood loss. Blood loss on average is about twice as much with a cesarean birth than with a vaginal birth. However, blood transfusions are rarely needed during a cesarean section.
* 3. Decreased bowel function. The bowel sometimes slows down for several days after surgery, resulting in distension, bloating and discomfort.
* 4. Respiratory complications. General anesthesia can sometimes lead to pneumonia.
* 5. Longer hospital stay and recovery. Three to five days in the hospital is the common length of stay, while it is less than one to three days for a vaginal birth.
* 6. Reactions to anesthesia. The mother’s health could be compromised by unexpected responses (such as blood pressure that drops rapidly) to anesthesia or other medications during surgery.
* 7. Risk of further operations. For example, hysterectomy and bladder repair. Researchers at the Wake Forest University School of Medicine also studied the effects of cesarean section and the results were alarming. After a seven-year, population-based, case-control study in North Carolina, the researchers concluded that cesarean sections cause two to four times more women to die in childbirth than in vaginal deliveries. The authors looked at many factors: demographics. , medical risk factor, preterm delivery, use of prenatal care and health services, including mode of delivery, to determine which factors were associated with maternal mortality. Style of birth (caesarean or vaginal) was the most significant factor linked to maternal mortality, although whether or not the mother sought prenatal care also had an effect. The study found that the pregnancy-related death rate among women with cesarean deliveries was 35.9 deaths per 100,000 cesarean deliveries with a live birth outcome compared with 9.8 deaths per 100,000 vaginal deliveries without complications. The death rate for the population assumed to have had elective cesarean deliveries was 18.4 per 100,000 cesarean deliveries. They concluded, “Removing barriers to and actively promoting use of prenatal care services and decreasing the rate of cesarean deliveries could decrease the number of pregnancy-related deaths. .”
The increase in cesarean births, either by choice or by doctor’s order, in the United States is surprising. The World Health Organization (WHO) states, No region in the world is justified in having a cesarean rate greater than 10 to 15 percent. However, more than one quarter of all children born in the United States in 2002 were delivered by Cesarean; the overall cesarean delivery rate of 26.1 percent was the highest level ever reported in the United States. While the cesarean delivery rate declined during the late 1980s through the mid-1990s, it has increased since 1996. In addition, the number of cesarean births to women with no previous cesarean birth jumped 7 percent and the rate of vaginal births after previous cesarean deliveries (VBACs) fell 23 percent.
Despite all efforts to convince mothers that a caesarean section is as safe if not safer for mother and child than vaginal delivery, the United States continues to rank 8th in infant mortality among industrialized nations (behind the Czech Republic and Cuba) as of 1998. .in the world for maternal death . However, the Centers for Disease Control (CDC) estimates that maternal deaths are underreported by half to two-thirds, and that half of American maternal deaths are preventable. The rate of death from childbirth has not decreased since 1982, and increased in 1999.
In an editorial for Obstetrics and Gynecology, Dr. Ingrid Nygaard and Dr. Dwight Cruickshank argue that while they believe that offering healthy women planning small families an elective caesarean section is justifiable, they do not condone such a recommendation on a routine basis .
“There are many unanswered questions about elective cesarean delivery at term, and it is important that we try to answer them before doing this part of the informed consent process. How should we manage the woman who gives birth before 39 weeks? Is there a point in labor (dilation and descent) at what time is it too late for cesarean delivery to benefit the pelvic floor? At least according to anorectal physiology, the protective effect of cesarean delivery is pronounced only if delivery is affected before cervical dilatation of 8 cm. Is it fetal size or gestational age below which vaginal delivery is not harmful to the pelvic floor?As more American women become obese, will the risks of elective cesarean delivery be greater than anticipated?Obesity itself is a risk factor for urinary incontinence, which can further decrease the value of preventive cesarean delivery in this population Given that some racial and ethnic groups are more predisposed to prolapse and inconti nece than others, do we manage all patients similarly , or do we take such considerations into account? How should we analyze the economics of cesarean delivery on demand? Projecting future cost should not rely on the arbitrary charge structure in place today. How do we balance the cost of elective cesarean delivery with that of treatments for pelvic floor disorders?
“Given the absence of rigorous scientific evidence, we believe it is currently ill-advised to routinely give all prenatal patients the choice of their desired mode of delivery. What appears to be a fairly low-risk proposition in non-obese healthy women having only one or two children is unlikely to are insignificant in obese women, women with poor nutritional status or medical conditions, or women who will have multiple cesarean deliveries.”
What most obstetricians and midwives agree on, whether for or against elective caesarean section, is that mothers need to be informed of all their options and the benefits and risks of both. Childbirth, even in the 21st century, is still a risky business and having all the information available is the only way mothers can be sure they are getting the best care.
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