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 fad of sorts. Do Yoga at 8 a.m. Have your baby at 10 a.m. It not only fits your schedule, but your doctor’s and you get the added benefit of avoiding anything remotely like a labor pain.
Sandy, 34, had an elective Cesarean section and frequently encourages other women to do the same.
“It is so exciting to finally hear other women and members of the obstetric community saying what I have said for the last six years,” she said. “I had an elective Cesarean section with my first pregnancy because I had a wonderful female OB who respected my desire to avoid vaginal and pelvic floor trauma. My section was awesome - wide awake and no pain, I was up walking in less than 8 hours.”
Diverse attitudes between doctors and mothers about the “right” way to deliver a baby are not only causing confusion for new mothers who are frightened about their first labor and delivery experience, but divisiveness among feminists. For many years feminists fought for the right to take control of their bodies once again and deliver babies naturally without the unnecessary medical intervention that women throughout much of the twentieth century were subjected to. Now, a new generation of feminists assert that it is also their right to choose to deliver their baby without pain. But how safe is an elective Cesarean section?
Some studies and doctors claim that elective Cesarean is just as safe – if not more so than a vaginal delivery and that the possible side effects of a vaginal delivery make c-section even more attractive.
Dr. Jennifer Berman, a urologist, author and television personality, said that she elected to have a Cesarean section with her second child and wished she had done so with her first.
“I had a very difficult time with the delivery 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 have been a seven-pound baby, but was actually nine pounds, eight ounces. His head and shoulders got stuck in the birth canal and he suffered fetal distress. Given my body habitus, he should have been delivered c-section, but I persevered and delivered vaginally.
“My second reason for choosing c-section stems from the work I’ve done 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 c-section. I experienced incontinence for seven months after Max’s birth and it began to recur during this pregnancy.
“Had I seen patients with such problems before Max was born, I would have elected to have a c-section with him, too. I decided that I didn’t want to risk more incontinence or prolapse in the future.”
A study performed by H. P. Dietz, MD (Heidelberg) and M. J. 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, in particular operative delivery, negatively affects pelvic organ support. This appears to be true for all three vaginal compartments. All forms of cesarean delivery were associated with relatively less pelvic organ descent. These findings may partly 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 highly significant increases in organ mobility. In addition, the length of the second stage of labor correlated with an increase in pelvic organ descent, suggesting that vaginal delivery is a major contributor to pelvic organ prolapse.
However, what many advocates of elective Cesarean section do not mention is the fact that the same study also states that the most significant pelvic floor damage occurred in women who experienced 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, while maintaining that every woman should have the right to choose between a Cesarean section and a vaginal delivery, also concedes that many pelvic floor issues (urinary incontinence, uterine and bladder prolapse) can be prevented by improved labor and birth techniques.
Episiotomies are also associated with pelvic floor damage and long-term complications. They have been proven 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 Cesarean section is much safer for the baby is also contentious. In fact, the risks to the baby can be substantial. Cesarean section is major surgery and brings with it many risks to both mother and child. Babies born by Cesarean section do not receive the natural stimulation that comes from moving down the birth canal, and therefore must often be given oxygen or a rub down to help them breathe. They also miss out on the natural hormones that are released during vaginal birth to help the baby during his first moments of life.
According to the Mayo Clinic’s “Complete Book of Pregnancy & Baby’s First Year” the risks of Cesarean section are substantial for mother and child:
1. Premature birth. If the due date was not accurately calculated, the baby could be delivered too early.
2. Breathing problems. Babies born by Cesarean 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 can be an effect of the anesthesia and Cesarean 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 by vaginal birth.
4. Fetal injury. Although rare, the surgeon can accidentally nick the baby while making the uterine incision.
Risks to the mother are more common and include: