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The Under-publicized Risks Of Caesarean Sections

About ten years ago, I devoted several months of my evening hours researching the ins and outs of C-section deliveries. I was stunned to discover that in some cases, C-section deliveries are encouraged because they are more profitable and convenient for doctors to perform, even though C-sections are clearly more dangerous than natural vaginal deliveries that take place in a supportive environment.

At that time, I vowed to share what I had learned about the risks of C-sections and the possible motivations behind promoting them with as many expectant parents as possible. Although I have stuck to this vow while in private practice for the past ten years, it has been discouraging to see the rate of C-section deliveries continuously climb over the years.

According to recently released data, in Canada, the number of C-section births rose from 5.2 percent in 1969 to 25.6 per cent of the annual total in 2003. That's a quarter of all deliveries in Canada being carried out by major surgery with major risks in 2003. The worst part of this statistic is that some patients are led to believe that C-section deliveries carry few risks and actually offer many advantages to healthy mothers.

To be fair, there is some evidence in the medical literature that indicates that a planned C-section delivery may provide the following benefits:

  1. Reduced risk of the mother experiencing pelvic disorders, the most common of which are urinary incontinence, fecal incontinence, and pelvic organ prolapse
  2. Reduced risk of having an unexplained stillbirth or having the baby experience health problems related to:
    • Cord prolapse
    • Breech presentation that doesn't respond positively to manual manipulation
    • Abnormalities with heart rate
    • Inflammation and possible infection of the membranes that surround the fetus (chorioamnionitis)

But these potential benefits are, in my opinion, far outweighed by the potential risks of unnecessary C-section deliveries.

A major new study published in this month's issue of the Canadian Medical Association Journal warns that C-section deliveries may be three time more dangerous for healthy mothers than natural vaginal deliveries. The study indicates that the most common health risks for women who undergo a C-section delivery are:

  • Myocardial infarction (heart attack)
  • Development of dangerous blood clots
  • Infection
  • Need for hysterectomy

Other studies have shown that planned caesarean deliveries are associated with an increased risk of death or health complications in the newborn. Two recent studies published in Obstetrics & Gynecology (2006) and the American Journal of Obstetrics and Gynecology (2005) found that full-term babies whose mothers chose to have a C-section before experiencing labour were at higher risk for the following:

  • Neonatal respiratory problems
  • Persistent pulmonary hypertension
  • Asphyxia
  • Delayed neurologic adaptation
  • Neonatal intensive care admission
  • Lacerations
  • Delayed establishment of breastfeeding

With increasing numbers of women choosing C-sections without a clear medical need, these under-publicized risks of C-section deliveries need - well, more publicity.

As Dr. Robert Liston, a lead author of the most recent study cited above, has said, "Look, caesarean section is not just like falling off a log. There are health issues that result from the operation, significantly more so than a planned vaginal delivery."

Expectant mothers need to know that there are serious risks to choosing to have a C-section. Ideally, such a choice should not be made because of a busy schedule, vanity-related issues like fear of weight gain, or the desire to avoid pain associated with childbirth.

For support and more information on this topic, I give my highest recommendation to the following books:

Ina May's Guide to Childbirth - Excellent for those seeking support for a natural childbirth.

Women's Bodies, Women's Wisdom: Creating Physical and Emotional Health and Healing - Provides useful information on a variety of women's health issues.

Reclaiming Our Health: Exploding the Medical Myth and Embracing the Sources of True Healing - One of the best books I have ever read in this arena.

 
 

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Comments

Thanks, Dr. Kim, for your comments about the widespread use of cesareans. It's a hard choice to make when you feel that you might be putting your child at risk by working for a vaginal birth. Ultimately, I came to feel that the risks of cesarean were higher than the risks of vaginal child birth, even though my baby was breech. I found out at about 36 weeks that my baby was breech. Despite numerous attempts to turn her, she just stayed put. The home birth I had planned with my midwife no longer seemed possible, since she was uncomfortable with doing a breech home birth.

I tried to get permission from my obstetrician to do a vaginal birth in the hospital, but she also was without experience and didn't feel comfortable saying yes. (Insurance companies often help set hospital policies and can make it nearly impossible to have a hospital allow a woman a vaginal breech birth.) After a CAT scan of my pelvis, which showed plenty of room, numerous additional tests, and a meeting with another obstetrician, she said she would agree to help me attempt a vaginal birth, IF I gave birth while she was on duty and within 12 hours. The chances were very slim that things would work out quite that perfectly.

I did a lot of research, meanwhile, on what breech means. Baby presents bottom or feet first, and about 4-7% of babies present this way. There are skills and knowledge that can allow most breech babies to be born naturally (90% of breech babies were born naturally as late as 1970), but these skills are being lost through disuse. I found a midwife who was willing to let me try for a vaginal home birth. After 18 hours of labor, I gave birth to my first child bottom first in my home with my husband, doula and 2 midwives in attendance. It was a difficult but wonderful experience. I feel so blessed to have been able to give birth to my daughter in this way.

Please do not assume that breech is an automatic reason for cesarean. Thank you!

Birthing has its own clock! Unfortunately, women are being undermined by doctors when it comes to the process of birthing.

To all of you pregnant goddesses, birthing is a natural process.

Gain your power back and know that these bones are made for birthing as intended by Mother Nature. Prepare yourself by learning yogic breathing techniques, conscious relaxation and labor postures to empower you.

When in labor, stay on your feet, feel the ground beneath you supporting you, breathe mindfully, grunt, moan, relax and do nothing extra. Trust your breath and your body's wisdom to guide you.

Recommended inspirational reading:
BIRTHING FROM WITHIN is an extraordinary guide to childbirth preparation by Pam England and Bob Horowitz.

Namaste, Diane

There is a very effective method for turning a breach baby used by Acupuncturists. A number of points along the meridians of the mother's body can be used to draw the energy downward and turn the baby.

This method is so effective that it is contraindicated during normal pregnancy as in any situation other than a breach baby, it can cause miscarriage by the drawing down of the energy. When you find out your baby is facing the wrong way, know that you can always find a good acupuncturist to use a more natural and painless method to turn the little guy (or girl).

One issue that many people also forget is that the first bacteria to colonize the gut of the infant-and therefore allow the intestines to do their job effectively-are introduced by the infant ingesting them off of the mother's vaginal canal. This is a very important step in the first few days of life. If the child is delivered via C-section, they will not get the beneficial microbes, and that puts them at a greater risk of illness, considering how important the intestines are to our immune function. Except for the latest hubub over Group B Strep, the bacteria in the birthing canal are beneficial and can help prevent more malicious species from getting a foothold in the colon.

This is just hypothesis because it's been a while since I've studied the physiology of childbirth...but it seems to me that the other infant health issues listed are all linked. I know that the first breath taken is designed to create a pressure difference that prompts a chain of events in the heart and lungs. (It includes, among other things, a flap closing off the connection in the internal heart wall.) Therefore it would also seem to stand to reason that there is a hormonal surge of some form, while the infant is in the process of labor, that prepares the child's body for this change. If this is the case, then it follows that a C-section poses a risk of bypassing this function and places undue strain on the body to catch up. That would account for numerous respiratory issues listed above, and because the brain's supply of oxygen would be compromised by any of these, the delay in neurologic development is highly feasible as a result.

All in all, our ancestors did it for millenia without doctors to rush them through it, and they still survived. Listen to the wisdom of your body...it's not rushing off to a golf game!

 

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