The New Trend in Childbirth: Elective Cesarean Section

By: Jenny Walters

21 months ago I gave birth to my beautiful daughter through natural childbirth. During my pregnancy, I never once thought of undergoing a cesarean section (c-section). The only reason I felt a c-section would be warranted was in an emergency situation. However, following the birth of my daughter, I began to hear from more and more women who were scheduling elective c-sections.

A recent article in Time magazine written by Alice Park and entitled Choosy Mothers Choose Caesareans discussed the rising trend of elective c-sections. According to Park, c-sections accounted for 31% of all live births in 2006; a 50% increase from 1996.1 In places such as Brazil, c-sections account for 80% of all live births.1

The article focused on one mother who knew before she was married she would undergo a c-section. However, this mother did not base her decision to undergo a c-section on health related issues; instead she based her decision on the “combination of having watched traumatic vaginal deliveries in medical school and hearing about her mother’s difficult emergency c-section after trying to deliver vaginally.”[1]

Why are more women choosing elective c-sections?

Eugene Declereq, a professor of maternal and child health at Boston University School of Public Health, stated: “the biggest change may simply be the way we think about labor and delivery. In an increasingly technological and medicalized society, maybe even childbirth is losing some of its magic and becoming less about the miracle of life and more about simply getting a baby out safely and without incidence.”1

Cesarean Section Facts:

There are numerous reasons c-sections take place: [2]
· Placenta previa: Placental lies low in the uterus and partially or completely covers the cervix. Incidence: 1 in 200 women
· Uterine rupture: Uterus tears during pregnancy. Incidence: 1 in 1,500 births.
· Placental abruption: Separation of the placenta from the uterine lining that usually occurs in the third trimester. Incidence: 1% of all pregnant women.
· Breech position: Cesarean is usually only option with breech babies.
· Cord prolapse: Umbilical cord slips through the cervix and protrudes from the vagina before the baby is born. If this occurs, an emergency c-section is required. Incidence: very low.
· Fetal distress: Most common cause for c-section is lack of oxygen to the baby. An emergency c-section is required in this situation.
· Failure to progress: Occurs when the cervix has not dilated completely, labor has slowed or stopped, or the baby is not in an optimal delivery position.
· Diabetes: Gestational diabetes can lead to a very large baby, increasing the need for a c-section.
· Repeat c-section: A common misconception is, once you undergo a c-section, you must undergo another one for each subsequent birth. However, according to the American Pregnancy Association, 90% of women who underwent a c-section are candidates for a vaginal birth.

The risks involved in a c-section:[3]
· Infection: Incision site, uterus, or pelvic organs
· Hemorrhage or increased blood loss: 1 to 6 women per 100 c-sections require blood transfusions.
· Injury to organs: Bowel and bladder risk (2 per 1002)
· Adhesions: Scar tissue can form inside the pelvic area, causing blockage and pain.
· Extended hospital stay: 3-5 days
· Extended recovery time: Can be extended from weeks to months.
· Reactions to medications: Reaction to the anesthesia.
· Risk of additional surgeries: Example: Hysterectomy or bladder repair.
· Maternal mortality: The maternal mortality rate for c-section is greater than vaginal birth.
· Emotional reactions: Some women have negative feelings towards their birth experience.
· Breathing problems for the baby: When delivered via c-section, a baby is more likely to have breathing and respiratory difficulties.
· Low APGAR scores: Can be a result of the anesthesia, fetal distress before delivery or lack of stimulation during delivery. Babies born via c-section are 50% more likely to have lower APGAR scored than babies born vaginally.

What does this all mean?

As the article in Time came to a close, the author remarked on the soaring malpractice rates for obstetricians, and remarked: “doctors are sued more frequently after vaginal births than cesarean; surgery is often the prudent choice when there is even the slightest indication of a difficult vaginal birth.”

The soaring malpractice rates in combination with an increasing number of women choosing elective c-sections, forces one to ask: In the future will c-sections become more prevalent than vaginal births? Dr. William Callaghan, an obstetrician at the Center for Disease Control and Prevention stated: “We put a lot of emotional, psychological, and spiritual value around birthing. But perhaps we are coming up with different cultural norms.”1

For me, natural childbirth was a moving, humbling, and glorious experience. Although it involved a great deal of pain, it is an experience I would never take back.


[1] Park A. Choosy mothers choose caesareans. Time. April 2008. Available at: http://www.time.com/time/magazine/article/0,9171,1731904,00.html. Accessed on May 25, 2008.
[2] American Pregnancy Association. Reasons for a cesarean birth. Available at: http://americanpregnancy.org/labornbirth/reasonsforacesarean.html. Accessed on May 25, 2008.
[3] American Pregnancy Association. Risks of a cesarean procedure. Available at: http://americanpregnancy.org/labornbirth/cesareanrisks.html. Accessed on May 25, 2008.