A cesarean section involves delivering a baby through an incision in a woman's abdomen and uterus. Approximately 15% to 20% of U.S. babies are born by cesarean section -- a significant increase from the 3% to 5% rate of 25 years ago. Although the media like to put a negative spin on this increase by focusing on the number of unnecessary cesareans, what often gets left out of the discussion is the number of babies whose lives have been saved or improved because of this increase in the cesarean rate.
This isn't to say that the 25% or higher cesarean rate at some institutions is something to cheer about, however. Cesareans continue to be four times riskier than vaginal deliveries (at least according to oft-quoted studies; in some patient populations, however, the difference in risk appears to be significantly smaller). Potential complications include
- infections (particularly of the uterus, the nearby pelvic organs, and the incision)
- excessive blood loss
- complications from the anesthesia
- blood clots due to decreased mobility after surgery
- bowel and bladder injuries
You may have heard a common myth about cesareans: that the baby misses out on the squeezing motion of a vaginal delivery -- a process that helps clear amniotic fluid from the lungs and stimulate the circulation. There's no evidence showing that babies delivered through cesarean section are at a disadvantage because of this so-called lack of squeezing. In truth, a fair bit of squeezing does occur as the doctor guides your baby out through the incision he or she has made in your uterus.
Still, most caregivers agree that cesareans should be planned only when there's a solid medical reason for avoiding a vaginal delivery. Here are some common reasons:
- The baby is predicted to be too large to pass through your pelvis.
- The baby is in a breech or transverse position.
- You have placenta previa.
- You have an active genital herpes infection.
- You have previously had a cesarean section.
Note: Not all women who have previously had a cesarean section are candidates for a repeat cesarean. The cause of your previous cesarean (for example, a one-time emergency versus a chronic problem), the type of uterine incision used, and your obstetrical status during your subsequent pregnancy will determine whether another cesarean will be necessary. We'll be discussing this issue further on in this chapter.
What a cesarean birth is like
If your section is planned rather than the result of an obstetrical emergency, you can expect your birth to proceed something like this:
Up until now, we've been talking about planned cesarean sections. An emergency cesarean section may be required if, during the course of labor,
- the baby's heart rate becomes irregular, indicating that she may be in distress and may not be able to withstand the stress of continued labor;
- the flow of blood and oxygen through the umbilical cord is being excessively restricted because of the position of the cord or the baby;
- the placenta has started to detach from the uterine wall (placental abruption);
- the baby is not moving down into the birth canal because the cervix has stopped dilating or the baby is too large for the mother's pelvis, or because of some other obstetrical complication.
How you may be feeling about having a cesarean
When you first found out you were pregnant and started thinking about the birth of your baby, you may have envisioned giving birth peacefully in the birthing suite at your local hospital or birthing center. Finding out midway through your pregnancy -- or in the heat of labor -- that you're going to require a cesarean section can be a bit of a shock.
Part of the problem stems from the fact that cesarean births are stigmatized as being less intimate and meaningful to laboring women and their partners than vaginal deliveries. This attitude angers women like Andrea, 27, a first-time mother. "Women need to realize that having a cesarean birth makes them no less of a mother than women who have vaginal deliveries," she insists.
Sometimes all that is required is a shift in mind-set, says Jennifer, a 25-year-old mother of one: "I had to plan a C-section when my baby was found to be breech two weeks before my due date. I was very disappointed not to be able to experience labor and delivery as I had envisioned, but I quickly convinced myself that this could be a wonderful thing as well -- to be able to relax and enjoy my baby's entrance into the world without even thinking about my performance and my breathing techniques."
If you continue to feel disappointed about your inability to deliver your baby vaginally, you may wish to share your feelings with your caregiver or talk with a therapist.