Know Your Options
A cesarean section or C-section is a surgical procedure used to deliver a baby through incisions in the walls of the abdomen and uterus. It is a common term under the subject of pregnancy and continues to hold its place as the most common operating room procedure in U.S. hospitals. April is Cesarean Awareness Month and our focus is to raise awareness in an attempt to reduce the number of cesareans that may be unnecessary.
For many women a cesarean section is needed when there is high risk of complications with a vaginal birth. Common situations that usually (or at times) require a C-section include:
- Breech position of the baby
- Placenta previa (when the opening from the womb to the vagina is covered by a low lying placenta)
- Severe medical problems like high blood pressure (“toxemia”) or seizures
- Possibly if the mother to be were involved in a motor vehicle accident and suffered trauma
- Lack of progress in active labor due to a baby who is too large for the vaginal route
- A serious question about the baby’s well-being (e.g. abnormal heart rate patterns) strongly suggesting that further labor is dangerous to the baby.
The availability of cesareans can help avoid major birth complications for mother and baby when faced with the above situations. However, there are also increased risks of maternal complications (and sometimes even complications for the baby – see the next paragraph) with C-section over vaginal delivery. These risks may include bleeding, infection, pneumonia, and injury to other organs such as the bladder or bowel. Recovery from a C-section also takes longer, typically about 4-6 weeks to heal fully. These may be unnecessary/undesired risks for elective C-section especially when factoring in potential problems for mother and child in the future.
According to the March of Dimes, a non-profit organization working to improve the health of mother and babies, babies born by C-section may experience more breathing and other medical problems than babies born by vaginal birth. Every week counts in the baby’s development. The 39 week rule advises against elective deliveries before 39 weeks for healthy pregnancies. This gives babies adequate time to develop important organs (lungs, brain and liver), as well as increase weight and strengthen hearing and vision. Mothers who have had C-sections and undergo them in subsequent pregnancies increase their chances of further complications. The good news is that having one C-section does not mean vaginal birth is no longer an option in future pregnancies.
Though C-section is a common term, VBAC is perhaps a less familiar one. Vaginal Birth After Cesarean may be possible with success rates ranging from 60-80%, therefore additional c-sections are not necessarily an automatic choice. A Trial of Labor After Cesarean (TOLAC) is a newer term used for attempting to labor in the hopes of delivering by a VBAC. There’s a slight distinction, but primarily a TOLAC is the process that may lead to a VBAC.
Favorable Factors increasing the success of VBAC are:
- Previous vaginal delivery
- Going into labor naturally as opposed to having labor induced
- Reason for previous C-section is not likely to recur, such as breech presentation or fetal distress
Unfavorable factors decreasing the success of VBAC are:
- Being overweight
- Pregnancy beyond 40 weeks
- High birth weight of the baby
- Pregnancy induced hypertension
- Short time span between pregnancies
As of December 2011, the preliminary U.S. national C-section rate for 2010 was 32.8% when evidence suggests that a rate of about 5-10% is optimal for positive outcomes for both mother and baby. The benefits of vaginal birth versus surgical birth should not be overlooked; these include:
- Faster recovery time
- Shorter hospital stay
- Prevention of potential complications of surgery including blood loss, infection, anesthesia risks, injury to bowel and urinary tract, blood clots in the leg, and death (maternal death rate is 18.4 per 100,000 for C-section, twice the rate for vaginal birth)
- Easier time with breastfeeding without an abdominal incision
- Emotional benefits of successful vaginal birth
Early in her pregnancy, an expectant mother should discuss every option with her physician or clinician. Through education and awareness new mothers and babies will have the safest, healthiest options available in women’s healthcare.