C-Sections and VBACS

The C-section rate has risen dramatically in the U.S. averaging as many as 25% of all births. Whereas many women are led to beliveve that c-sections may be safer than natural, vaginal deliveries and planned births are more convenient, there is much evidence in the literature to indicate otherwise.The following studies are provided to increase your awareness about the risks of c-section and the links below will lead you to extensive resources on the subject.

Soaring C-section Rates Cause for Alarm

Cesarean section rates are off the charts and women are being duped into thinking that this is all right; in fact they are being enticed to consider c-sections on demand based upon questionable promises.

A woman considering cesarean section should be told that, compared to vaginal birth, she has an increased risk of infection, hemorrhage, damage to abdominal and urinary tract organs, and complications from anesthesia/narcotics. She needs to know that the incidence of drug resistant infections is increasing and blood transfusions can lead to life threatening complications. She should also be told that she will probably not be allowed to attempt a vaginal birth in the future, and that the risk of complications from cesarean section increase with each subsequent surgery. Recent studies note higher rehospitalization and draw a direct link between chronic pelvic pain and cesarean section. These complications can ultimately limit her ability to have the number of children she desires.

The American College of Nurse-Midwives

Cesarean Section Increase: Cause for Concern

In Great Britian, the number of women giving birth by c-section increased once again in 2001. Hospitals in England and Scotland now have a 22% rate and wales and Northern Ireland is up to 24%

The New Zealand Ministry of Health is concerned that a growing proportion of c-sections in the country is done for the convenience of the mother and/ or physicianIndividuals and organizations are speaking out against these “social cesareans.” National maternity manager Barbara Browne says, “The health sector needs to support women around the time of childbirth to help them feel strong.” The C-section rate in New Zealand has risen from 12% in 1988 to 20% in 2001. The WHO estimates that the rate of C-section should be between 5 and 15% of all births.

Mode of delivery and asthma -- is there a connection?

The results of this study in Finland suggests that caesarean section delivery may be associated with an increased prevalence of atopic asthma.

Kero J, Gissler M, Gronlund MM, Kero P, KoskinenP, Hemminki E, Isolauri E   Mode of delivery and asthma -- is there a connection?   Pediatr Res. 2002 (Jul);   52 (1):   6-11

C-Sections may up risk of asthma.

Natural childbirth may prevent a baby from developing asthma later in life, according to a just-published report.

Investigators followed 1,953 Finnish subjects from their birth in 1966 to their third decade of life in 1997. The 5.3% of subjects who were delivered via Cesarean section were three times more likely to have developed asthma by age 31, compared with subjects delivered vaginally. However, delivery method did not influence risk of other allergic disorders.

Xu B, Pekkanen J, Hartikainen AL, Jarvelin MR   Caesarean section and risk of asthma and allergy in adulthood   J Allergy Clin Immunol. 2001 (Apr);   107 (4):   732-733

Babies delivered by elective cesarean have an increased risk of neonatal respiratory distress syndrome (RDS), a life-threatening condition and other respiratory problems that may require NICU care.

Levine EM, Ghai V, Barton JJ, Strom CM   Mode of delivery and risk of respiratory diseases in newborns   Obstet Gynecol 2001;   97 (3):   439-442

Neonatal respiratory distress syndrome (RDS) is an important complication of elective repeat cesarean section. Awaiting the onset of spontaneous labor to determine the timing of repeat cesarean section in women at term is an effective way to preventing iatrogenic neonatal RDS.

Bowers SK, MacDonald HM, Shapiro ED   Prevention of iatrogenic neonatal respiratory distress syndrome: Elective repeat cesarean section and spontaneous labor   Am J Obstet Gynecol 1982 (May 15);   143 (2):   186-9

Iatrogenic RDS continues to occur in the setting of elective repeat cesarean delivery and is associated with a failure to adhere to clinical protocols.

Parilla BV, Dooley SL, Jansen RD, and Socol ML Iatrogenic respiratory distress syndrome following elective repeat cesarean delivery Obstet Gynecol. 1993 Mar;81(3):392-395

Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section.

Morrison JJ, Rennie JM, Milton PJ Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section Br J Obstet Gynaecol. 1995 Feb;102(2):101-106

Influence of labor and route of delivery on the frequency of respiratory morbidity in term neonates.

Hales KA, Morgan MA, Thurnau GR Influence of labor and route of delivery on the frequency of respiratory morbidity in term neonates Int J Gynaecol Obstet. 1993 Oct;43(1):35-40

Neonatal respiratory distress is a major complication of elective Cesarean section. Awaiting the onset of labor appears to be beneficial in preventing neonatal RDS for term neonates delivered by elective Cesarean section.

Yang JY, Fang LJ, Tsou Yau KI Labor pain before elective cesarean section reduces neonatal respiratory distress Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1997 Jan-Feb;38(1):38-43

Study Links C-Sections, Stillbirths
Procedure May Put Subsequent Pregnancies at Risk, Study Says

Having a Caesarean delivery may increase the risk of having a stillbirth in a second pregnancy, researchers said. Doctors at the Rosie Hospital in Cambridge, England, who studied data on 120,000 births in Scotland between 1992 and 1998, found that stillbirths were higher among women who had previously had a child by Caesarean section.

"Delivery by Caesarean section in the first pregnancy could increase the risk of unexplained
stillbirth in the second," Gordon Smith, who headed the research team, said Friday in a report in The Lancet medical journal. "Our best estimate is that for every 1,000 women with a previous Caesarean section, there will be one additional stillbirth in comparison if they hadn't had a previous Caesarean section," he added in an interview.

Doctors are not sure why the surgery increases the risk of stillbirth but they suspect that repairing the uterus after the surgery could affect the function of the placenta, which nourishes the fetus, in a future pregnancy. Scarred tissue also works less well than unscarred tissue.

"This is a factor that women should take into account when deciding to have a Caesarean section," Smith said. "Our results are of relevance for women considering Caesarean delivery who are planning future pregnancies."

Reuters Friday, November 28, 2003; Page A16 LONDON, Nov. 27

Additional Info

There is so much information available for women to read so they become informed about the rising frequency, risks to themselves and their babies, etc. Here are some links which offer the best compilation of information.

International Cesarean Awareness Network

ICAN's Links Pages
ICAN's Choices in ChildBirth

Additional Articles of Interest:

C-Sections: Are they Really a Safe Option?
Midwifery Today Archives
Mothering Magazine Archives