The Complicated Truth About C-sections

The truth about c-sections is complicated and riddled with misinformation, misguidance, and misjudgment. Bringing your baby boy or girl into the world will be, without a doubt, one of the greatest moments of your entire existence. However, it is also a moment that can approach with substantial fear and anxiety.

To understand the truth about c-sections and why rates are so high, we must look at the history of cesarean sections, evaluate the difference between medically necessary and elective, and how we can free ourselves from “fear of the unknown” through education.

A Brief History of Cesarean Sections

The mention of surgically removing a ready-to-be-born baby from an incision in a mother’s abdomen area is referenced in Hindu, Egyptian, Roman, and many other ancient European folklore. It even appears in Greek mythology when Apollo removes Asclepius from his mother’s abdomen.

This procedure has been used for hundreds of years, but it is only in relatively recent times that the survival rate for both the mother and child has become high. 

Prior to modern medicine, which includes proper anesthesia, stern sterilization techniques, the ability to treat hemorrhages quickly, and fast-acting antibiotics, c-sections were usually only performed postmortem or as the mother was on the verge of death amid childbirth.

However, there are accounts of successful cesarean sections where both mother and child survived as early as the 1500s. Advancements in the comprehensive understanding of human anatomy, innovative surgical techniques, and continual medical discoveries over hundreds of years helped doctors refine this procedure to the point it is at today as one of the most common operations performed worldwide. In fact, today, one in three babies in the United States are delivered via c-section.

Why You Would NEED a C-section

Cesarean sections are performed both electively and out of medical necessity. There are multiple reasons why a planned or emergency c-section would be your best and safest birthing option. As an expecting mother, your and your baby’s health and safety are of the utmost importance. If there is anything apparent that could stand in the way of your and your baby’s health and safety, a c-section will likely be recommended. 

These health and safety obstructions include: 

•    Stalled labor (your cervix isn’t opening enough despite contractions) 

•    Sudden and prolonged changes in your baby’s heartbeat due to distress 

•    A prolapsed umbilical cord, which disrupts your baby’s oxygen supply

•    Abnormal positioning (feet or buttock first)

•    Placenta problems (the placenta has detached by the uterine lining or covers the cervix)

•    Certain maternal medical conditions (active herpes infection, HIV, diabetes, high blood pressure)

The Truth About C-sections

Why Do Practitioners Use Them So Unnecessarily Often?

Around 10,000 babies are born every day in the United States. Among those, roughly 3,333 are born by means of c-section. It is generally agreed on by obstetricians that if you don’t need a cesarean section, you shouldn’t have one.

The issue, however, is that the line that separates when a vaginal birth is the safest route and when a c-section is deemed necessary varies from one obstetrician to the next and from hospital to hospital. 

There is no black and white answer to how long a woman should be pushing for or how long after her water breaks that the switch in the birth plan should be made from vaginal birth to c-section.

Also, now that continuous fetal monitoring is standard practice, there is even more gray area as to what specific readings justify an emergency c-section; aside from, of course, a very obvious reading, such as a prolonged spike or drop in heart rate. 

Because of all of this gray area, doctors are put in a tricky position. The risk of being sued and losing a medical malpractice suit is far slimmer when a c-section is performed, and the outcome is not favorable. The commonly accepted belief here is that everything that could have been done was done. 

However, the rate of medical malpractice suits for vaginal births that go wrong is significantly higher with the winning argument highlighting the doctor’s failure to perform a c-section to save the baby and or mother’s life. America’s sue-happy culture has forced many doctors to practice defensive medicine in order to protect themselves against a devastating and potentially career-ending lawsuit. 

Another suing issue comes from the fact that the profits from delivering babies through cesarean section are a bigger business than through natural vaginal birth.

Doctors may receive wages upward of 15% higher when the surgery route is taken, which in turn means that the hospitals are making more money too. 

The average out-of-pocket cost (with insurance) for a standard c-section costs around $5,161, while an uncomplicated vaginal birth delivery averages around $4,314. The actual hospital bill for a c-section is around $51,125 and an uncomplicated vaginal birth bill is about $32,093.

It should be noted that the United States has one of the highest birthing costs in the world. Aside from being life-saving and life-giving facilities, hospitals also operate as a business with a varying array of priorities and monetary-oriented pressures. 

Finally, some physicians and expecting mothers alike prefer to schedule an exact day and time to deliver a baby. This convenience factor has clouded the better judgment call of many doctors and uninformed mothers. It’s crucial to realize that convenience doesn’t automatically sync up to safety. This approach has been given the misleading name “designer birth.” While the pros of an elective c-section include removing the guesswork of when your baby’s birth date and time will be, the cons can potentially be quite heavy. 

In another study from 2006, researchers explored the motivation for drug addicts to get better. They discovered that life meaning provided context for a person to successfully cope with life’s hurdles. It was further noted that physical or mental discomfort could potentially arise if the personal meaning was blocked or unfulfilled. In turn, this could hinder a person’s ability to heal and recover from addiction. In contrast, when a person had a clear life purpose or vision, their ability to heal was enhanced. They were more likely to recover from addiction and move toward their ultimate vision.

In summary, the reason that a third of births in the United States involve a c-section, both elective and essential, relate to the great gray areas of risk, the practice of defensive medicine, monetary gains, and convenience.

Lesser-Known Impacts of C-sections

While there is undoubtedly a need for c-sections, there is no need for unnecessary c-sections. Since the beginning of our species, women have so successfully given birth that the human population is currently pushing eight billion. That said, there are definitely inherent risks for both mother and child during the birthing process, some of which sadly result in the loss of life. 

This fear of the unknown, often experienced more by first-time mothers, pushes some women toward the false security of an elective c-section. While there is an element of control during surgery, there is also a whole different set of unnecessary risks and problems that can occur during and after the procedure compared to uncomplicated vaginal births.

This includes, but is not limited to blood clots, injury to organs, massive blood loss, post-surgery infection, need for an emergency hysterectomy, adverse reaction to medication or anesthesia, post-surgery endometritis, and emotional trauma. 

Two lesser discussed complications that are more likely to occur post-c-section versus post natural birth relate to mother-baby bonding and breastfeeding.

Interruption of Mother-baby Bonding

Nature prepares a mother and her baby to need each other from the moment of birth.”

– Lamaze Institute for Normal Birth

Skin-to-skin contact is essential for both mother and child, as it promotes a sense of calm, well-being, and connection. This initial contact is also vital in stabilizing the baby’s breath, heartbeat, and glucose levels, colonizing the baby’s gut with the mother’s normal gut bacteria, and for metabolic adaptation, according to VBAC. 

This skin-to-skin contact is also responsible for the release of certain hormones, such as oxytocin, which stimulates the new mother to feel “motherly” toward her new baby. The separation between mother and child immediately after birth can impact how a mother responds and cares for her child, including breastfeeding.  

Postnatal depression is also more common in mothers who undergo a c-section. A possible reason is linked to the initial separation that is forced between mother and newborn child when a surgical birth is employed. 

A U.S Survey revealed that only 14% of mothers who underwent a c-section were able to hold their baby immediately after birth compared to 43% of mothers who gave birth vaginally. 

Fortunately, if a c-section is deemed the safest birthing plan, immediately following the birth, a baby can significantly benefit from skin-to-skin contact with the other parent, if that is an option.

Complications in Breastfeeding 

In congruence with interrupted bonding, breastfeeding can be negatively impacted when a mother and baby are separated after birth. The Center for Disease Control states that having a cesarean delivery makes it more difficult for mothers to “initiate and establish breastfeeding.” 

With nearly every type of surgery, there is an expected recovery period. The recovery and healing process can be painful and get in the way of a mother comfortably being able to breastfeed her child. 

Of course, breastfeeding is not impossible, nor is establishing that important initial bond if you do end up needing to have a c-section; it should just be noted that if a c-section is not necessary, opting for vaginal birth will reduce your risks of having breastfeeding complications or bonding issues.

Another Benefit of Vaginal Birth 

Unless you and or your baby are at high risk (either predetermined or become so during labor), vaginal birth is the safest way to bring your child into the world. A unique benefit of delivering your baby vaginally relates to the microbial community they are exposed to as they pass through the birth canal. 

Babies that are born vaginally emerge covered in the same bacteria that are found in their mother’s vagina, as opposed to a baby born via c-section, who end up with a microbiome similar to their mother’s skin. It is believed that this vaginal microbial exposure decreases the risk of future development of asthma, allergies, obesity, and immune deficiencies, according to Science Magazine writer Jennifer Couzin-Frankel.

Free Yourself from Fear 

According to the U.S. Department of Health and Human Services, 85% of American pregnancies achieve full term without complications. Cara Osborne, a professor at the Eleanor Mann School of Nursing at the University of Arkansas, believes that “an atmosphere of fear surrounding childbirth is driving more c-sections.” 

She also exclaims that, while childbirth is an “inherently risky endeavor, we’ve somehow gotten to a place where we’ve lost trust in our physiology.” We shouldn’t be scared into a c-section. Misinformation or lack of knowledge is the greatest fuel of fear and knowing that you can avoid fear-driven decisions by empowering yourself with adequate information. 

As women, we are the sole keepers of our bodies, and as long as our babies are inside of us, we are the sole keepers of them too. The decisions we make surrounding our health and childbirth are our own, and our relationship with our medical professionals should be more collaborative versus authoritarian. But, in order to collaborate, we must first empower ourselves with the right information and understand the complicated truth about c-sections.