Cesarean Sections as a Last Resort

Cesarean Sections as a Last Resort

Delivery

The most common surgery in the United States is the cesarean section (C-section), so named because Julius Cesar is said to have been born this way. It may also be the nation’s most overperformed operation, say many experts. Approximately 1 in 4 babies in the United States are delivered by cesarean birth; in Canada the rate is about 1 in 5, and in Great Britain it is 1 in 10. And while the rate of C-sections has leveled off in the United States since 1989, the incidence remains almost five times higher than it was in 1969.

The reason for the high volume of cesarreans may be as much legal as medical. The American College of Obstetricians and Gynecologists (ACOG) has suggested that physicians’ fears of being sued for their handling of difficult deliveries may be much to blame for the medical profession’s propensity to elect C-sections over vaginal deliveries in many cases.

The widespread use of electronic fetal monitoring, a technique that makes it easier for the doctor to detect potential problems in the delivery early, only adds to this jumpiness.

According to ACOG, a self-fulfilling prophecy may also be at work to some extent: once a woman has had one C-section, obstetricians have often fallen into a habit of assuming that a cesarean would be required should the woman ever give birth again.

Other critics have argued that the medical establishment’s fondness for cesareans is inspired by a more cynical factor: insurance reimbursement rules that provide substantially higher fees for doctors and hospitals performing C-sections than for those delivering without the need for surgery. These critics point to studies showing that cesareans are more likely to be performed in profit-making hospitals and on women with private health insurance.

Cesarean Section. Photo by Elena

Whatever the reasons, most experts agree that in the absence of medical complications, women should be encouraged to attempt vaginal labor rather than undergo a cesarean. Successful vaginal delivery significantly reduces the risk of complications, both during and after the surgery, as well as cuts down the stay required in the hospital from nearly five days to about half of that, with all the financial savings that that entails.

Even women who have had a prior C-section can deliver vaginally the next time around an 60 to 80 percent of cases, says ACOG. Vaginal deliveries are strongly discouraged, however, if a woman’s previous cesarean involved either a classical uterine incision, in which the cut was made in an up-and-down direction in the upper part of the uterus, or if warning signs such as an abrupt change in the fetal heart rate appear. Nevertheless, in most cases “the relative safety of vaginal delivery after cesarean birth is compelling,” says ACOG, and “women should be counseled and encouraged to undertake a trial of labor.”

Risk of miscarrying: Miscarriage is nature’s way of ending a pregnancy that is not proceeding normally. About a fifth of all pregnancies end this way, mostly during the first trimester, but in some cases as late as the first half of a pregnancy. Heavy bleeding from the uterine lining is the most common warning sign. Cramping pain, usually more severe than menstrual cramps, can also be a symptom