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The national cesarean section rate in the United States has steadily been rising for decades. Right now, it's at 32 percent of all births.

The national cesarean section rate in the United States has steadily been rising for decades. Right now, it's at 32 percent of all births. A cesarean section is generally a safe operation, and it saves many lives every day. Still, c-sections represent major abdominal surgery, and there are risks involved. What do you need to know about the medical risks of a cesarean, especially if you are considering an elective c-section — that is, choosing cesarean when it's not medically necessary for you or your baby? 

An overview of the risks of cesarean sections

Giving birth is always, let's face it, a little risky and historically, childbirth has been the number one cause of premature death among women. Driving a car has caught up with childbirth in modern times, but the risks are still there. A cesarean section is statistically more likely to cause complications than a vaginal birth. There is a longer recovery time, and a c-section also has implications for subsequent births. Long-term complications of cesarean births include adhesions, where scar tissue sticks to other organs and causes pain, and uterine rupture during future pregnancies or vaginal deliveries.

Cesareans are not unique in their risks; every operation carries the risk of complications. One thing that is specific to cesarean sections is that risks apply to two persons, the mother and the baby. Here is an overview of possible complications of c-sections, either during the operation or immediately afterward.

Risks for the mother

  • An infection of the incision site, or of other internal organs surrounding the uterus.

  • A blood clot in one of the legs, or in the lungs.
  • Hemorrhage, meaning you lose a dangerously large amount of blood.
  • Long after the surgery, adhesions caused by scar tissue can cause ongoing pain in some women.
  • Accidental damage to an internal organ, such as the bladder.
  • Death. Mind you, this is extremely rare.

Risks for the baby or babies

  • Being born prematurely, which all the risks associated.
  • Breathing difficulties, because the fluids that are present in the lungs were not squeezed out in the birth canal which usually happens.
  • Accidental injury as the incision is taking place.

All in all, c-sections are a lot safer for babies than for mothers.

When is a cesarean necessary, and when isn't it?

Though everyone has heard about women who are "too posh to push", it's very rare for a woman to decide to have a c-section just like that, without medical reasons. Those who question the high c-section rate wonder how many of them were truly medically necessary. There are many cases in which the need for a c-section is questionable. Doctors may decide to "play it safe" and recommend a c-section in cases where its need is debatable. We'll get to those in a bit. In the meantime, here are some great reasons to have a cesarean:

  • Placenta previa. This means that the baby's placenta is covering the cervix. As a result, the baby literally can't be born vaginally.
  • Cord prolapse. The umbilical cord has emerged from the birth canal before the baby during an attempted vaginal delivery. The baby's oxygen supply is cut off, and the baby's life is in great danger.
  • Breech baby. Vaginal breech deliveries were very common until recently, but research has shown that vaginal breech births end in complications more often than cesarean breech births. Vaginal breech deliveries can end with head entrapment, and some degree of cord compression is inevitable, since the umbilical cord is attached to the naval which will come out first. The head's birth will compromise the baby's oxygen supply.
  • Fetal distress. Fetal distress is registered through fetal monitoring during birth. Question your medical team about the risks vs benefits of a c-section in this case, since there are degrees of fetal distress, and some hospitals may feel more comfortable with a c-section at the first sign of distress but when the baby is still within the normal range. You may agree, or you may not. Informed consent matters in this case.
  • Twin birth, or higher multiples. Vaginal delivery may be an option too, but c-sections are definitely medically justified in this case, depending on the parents' wishes and the positions of the babies.

Now, onto debatable reasons to carry out a c-section:

  • "Big baby". If an ultrasound showed you're having a larger than average baby, don't forget to question your OBGYN about the accuracy of this method. Late-pregnancy ultrasounds are notoriously bad at correctly estimating a baby's size. There is no reason you can't try for a vaginal birth if you want to.
  • Overdue. From 42 weeks, the risks of stillbirth goes up and there's a clear reason for labor to be induced. There is no reason to jump straight to a c-section, however. Discuss induction with your doctor, instead.
  • Failure to progress. This means your labor is going more slowly than your medical team would like. Many hospitals "require" a baby to be born within 24 hours of the rupture of membranes. Again, you should discuss the risks of that situation with your doctor. The risks of the c-section should be compared with the risks of prolonged labor. Medications like pitocin would usually be tried first, and often they will help to kickstart labor.
  • A previous cesarean. Repeat cesarean sections are common practice for a reason vaginal birth does become more dangerous after a c-section. Many medical associations, including the American College of Obstetricians and Gynecologists (ACOG) hold that a vaginal birth after cesarean is a safe option much of the time. Discuss this with your provider if you're in that situation. Choose a doctor experienced in VBAC if you would prefer to go that route.

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