Elective C-sections reach epidemic levels around the globe
Recent data sheds light on elective C-section debate
When Jennifer Rose envisioned giving birth to her now nine-month-old son, Carter Jackson Rose, she never expected she would be wheeled into the operating room for an emergency cesarean section after nearly eight hours of labor and her son’s life at risk.
“His heart rate kept dropping with every contraction and the nurses worried that he wasn’t getting enough oxygen,” said the 35-year-old Solana Beach resident, who later learned that her umbilical cord was wrapped around her son’s neck. “Once I heard that my baby’s life was in danger, I didn’t care what happened next.”
Rose originally planned to have a vaginal birth, but nature threw her a curveball – and a painful one at that. Rose said her C-section left her with terrible bruising and more than six weeks of recovery, which, she said, was longer than it took her to recuperate from kidney surgery in 2004.
Although Rose wasn’t prepared for her C-section – a surgery she would not have elected to do – a growing number of women around the world are choosing to have C-sections at what health officials have called “epidemic” levels.
Elective C-sections on the rise
A boom in elective C-sections is putting women’s health at risk, said World Health Organization officials in an ongoing international survey recently published in the medical journal The Lancet.
The survey revealed that C-sections have reached “epidemic proportions” in many countries across the globe. The most dramatic numbers come out of China, where 46 percent of births were by cesarean section in which a quarter of them were not medically necessary. The report goes on to say that women who underwent elective C-sections were more likely to be admitted into intensive care or encounter complications that required a blood transfusion or possibly a hysterectomy.
In the United States, one in three babies is delivered by C-section, according to the National Center for Health Statistics. Of the more than 4.3 million babies born in the U.S. each year, 31.8 percent of them were delivered by C-section in 2007, a record high according to the Centers for Disease Control and Prevention.
This news may compel expectant mothers to evaluate the risks of an elective (or non-emergency) C-section, which health officials consider an unnecessary surgery.
C-sections a hot button issue online
Mom blogs are abuzz over the elective C-section debate. Many advocate that it is a woman’s right to choose how she wants to deliver her baby, while others go as far as to say a C-section isn’t considered a “real birth” and could potentially harm the baby.
Mo Davis-White of La Mesa said she never doubted her decision to have an elective C-section when it came time to deliver her now 5-year-old daughter, Sophie White.
“My husband and I went through years of fertility treatments and even a miscarriage trying to conceive our daughter,” said White, 48, who finally conceived with the help of an egg donor. “I chose to have a C-section because I was terrified of losing my daughter in the delivery process.”
Davis-White calls herself “holistic” and is opposed to taking unnecessary medications or drugs; however, she elected to have a C-section because she felt it was the safest way to deliver her only daughter.
“A couple of my friends almost lectured me on what I would miss not having a vaginal birth,” admitted Davis-White. “But I never once wavered on my decision to have a C-section.”
Scott Musinski, M.D., chairman of the Department of Obstetrics and Gynecology at Scripps Hospital Encinitas, says it is ultimately a woman’s right to choose how she wants to deliver her baby.
“It’s a little troubling that there is so much interest and scrutiny about what basically is a woman’s choice to do with her body,” said Musinski. “Often, women will look at the bigger picture. Since there’s a higher chance of them having a C-section if their labor goes unplanned, a scheduled cesarean section may eliminate any potential danger to mom and baby in the process.”
Women have both medical and aesthetic reasons for electing to have a C-section.
Those who delivered via C-section previously may elect to have a cesarean section for their second baby to avoid any complications from a vaginal birth. Today, women are waiting to have babies until they are older and opting for cesarean section to have their baby delivered quickly and with less physical stress on the mother, especially if the baby is too large to deliver vaginally.
Aesthetically, a woman may want a C-section to preserve her vaginal shape, often rumored to be stretched in the birthing process, or to ensure her newborn doesn’t have a “cone head” or any body marks that can result from coming down the birth canal. Women may even schedule a C-section for a specific day to help them prepare for absence from work and home.
Musinski says his patients are educated about the potential risks of an elective cesarean section, allowing them to make the most informed decision when it comes to the birth of their child. He will not honor a woman’s wish to have a baby pre-term, or before the full 39 weeks of gestation. In certain cases, Musinski will assess the degree of risk before granting a scheduled C-section prior to a woman’s full term.
Financial reasons could also influence a hospital’s motives for granting women an elective cesarean section. On average, C-sections cost hospitals around $2,000 per patient. By eliminating one C-section a year, hospitals could save a billion dollars, according to a recent CNN report.
Cesarean is section necessary in certain circumstances
Often, complications during labor may prevent expectant moms from having a vaginal delivery. When medically recommended, a scheduled C-section could be a lifesaving procedure when the health of mother and baby are at risk.
According to the American College of Obstetrics and Gynecology (ACOG), there are certain cases in which a planned C-section should be considered:
- Labor does not progress. One third of cesarean births are performed because labor does not progress normally, according to the ACOG. Doctors will often monitor women for a few hours before opting for surgical delivery.
- The baby’s health is at risk. An emergency C-section may be necessary if the umbilical cord is around the baby’s neck, if the baby has an abnormal heart rate, if it is too large to fit down the birth canal or is breached (delivering feet first instead of head first).
- There are problems with the placenta. The placenta is the organ that nourishes the baby in the womb. Placental problems could cause unsafe bleeding during vaginal birth.
- Multiple births. Women delivering multiple babies at once may need to have a cesarean delivery if the babies are born early or if they aren’t in a good position in the uterus for vaginal delivery.
- Previous cesarean birth. Women who had a baby by C-section previously may require surgery again as a vaginal birth could increase the risk of rupture to the uterus.
Local hospitals find elective C-sections hard to tally
While elective C-section rates reach peak levels globally, local hospitals say “elective” surgeries are hard to track. They do, however, report an increase in cesarean sections in general.
Sharp Healthcare reported 5,825 cesarean sections were performed in 2008 at Sharp Mary Birch, Sharp Chula Vista and Sharp
Grossmont hospitals, slightly more than the 5,578 performed in 2007. Hospital representatives say that since an elective C-section is decided between a patient and her doctor, they are unable to readily track elective C-section numbers.
The same is true for Scripps Hospitals countywide. Scripps tallied 3,447 C-sections during their fiscal year October 2008 through September 2009. That’s only 45 more than 2008.
Steven Carpowich, a Scripps Hospital spokesperson, says their doctors have seen the rate of elective C-sections remain stable over the past couple of years, with many of the procedures performed in “urgent” or “emergency” conditions.
“There is currently no clear community or regulatory standard as to the definition of ‘elective C-section,’” wrote Carpowich via email. He added that Scripps is working on developing a way to compare elective versus scheduled C-sections across the hospital system.
C-section vs. vaginal delivery: Pros and cons
A cesarean section is major abdominal surgery and a decision not to be taken lightly for women with otherwise healthy pregnancies.
First, the surgical process will leave women with a scar, require a longer recovery period than a vaginal birth (three to four weeks compared to one to two weeks, respectively), and could cause damage to the uterus. Women could potentially develop a hernia after a C-section, experience significant bleeding, or in some cases, require a hysterectomy – often occurring in women who give birth to multiple babies. A baby delivered via C-section is at increased risk for transient respiratory illness or injury, either from being cut or poked during the surgery.
But, despite the risks, a cesarean section could save a baby’s life should complications arise during labor.
The overriding opinion is that vaginal birth is safer for mother and baby, with the benefits of less recovery time and no major complications that could result from surgery. For the baby, traveling down the birth canal can help squeeze fluid out of the baby’s lungs allowing them to carry oxygen more quickly to the body tissues. In addition, many doctors believe that the stress of the vaginal birth process could help with baby’s transition into the world.
But vaginal birth is not without potential risks – including additional pain, blood loss and higher risk of infection from repeated pelvic examinations. Musinski says there is a 10 to 25 percent chance that a woman will have an unscheduled C-section when attempting to give vaginal birth.
Although Rose would not have elected to have a C-section, she looks at her healthy son today and knows the surgery was worth it. Regardless, she will still try to have a vaginal delivery when it comes time for baby number two.
“My delivery experience was traumatic,” recalled Rose. “It was upsetting to know my baby was suffering. If I could do it vaginally for my second child I would, so long as there wasn’t a high risk of complication for my baby.”
In the end, giving birth is a personal process for women. Expectant mothers should consult their doctor about the risks of cesarean section in order to make the best decision for both mom and baby.