At the beginning of the 21st century, caesarean section (or c-sections) became somewhat fashionable: it was done without medical rationale. At the request of the mother or the doctor, c-sections were performed because they were faster and easier and could be scheduled, unlike natural childbirth . But in 2015, WHO expressed concern about this practice and called for surgery to be used only when necessary.
Why not do c-section, if it's faster and easier?
Because, like any surgery, c-sections often leads to complications. Only when natural childbirth creates a danger for the mother or child, then a c-section is a better option.
Quite often, women choose c-section because of their fear of childbirth (known as tocophobia). Around the globe, about 14 percent of women experience it, and up to 7 percent of cases are a very strong fear [1, 2]. Most scientists agree that in such cases, psychotherapy for expectant mothers is much more effective and safer than “on demand” surgery.
What are the risks of a c-section?
Risks can be divided into two categories — early and delayed. The early ones arise immediately during or after operation and occur in about 14.5 percent of cases.
Early risks include:
- wound infections (most common);
- endometritis (inflammation of the inner lining of the uterus);
- internal bleeding;
- hematoma of the bladder (small hematomas occur at every second c-section and are considered normal, but a hematoma larger than 5 cm can lead to rupture of the uterus or sepsis)
- rupture of the uterus.
Delayed risks can develop years after the surgery. Researchers are still trying to understand more about delayed complications because when the risk occurs years later, it is not easy to establish a direct causal relationship. The chance of delayed risks is not well understood. According to various sources, the scar defect, for example, manifests in 20–88% of women who underwent c-section [3].
Delayed risks include:
- scar defect (dehiscence or thinning);
- endometriosis (due to the fact that during the operation the endometrial cells got to other organs, "took root" and grew);
- pelvic vein thrombosis;
- prolonged menstrual bleeding (up to 12 days);
- rupture of the uterus in subsequent pregnancies;
- increased likelihood of placental abruption or ingrowth in subsequent pregnancies [3].
What's best for the child?
There are situations where a c-section is better. Some factors where this is the case include:
- if the baby is very large;
- if the baby is experiencing oxygen starvation;
- if the baby is breech and simply cannot come out naturally;
- if the mother has an infection that can be transmitted to the baby during childbirth.
However, if these indications are not present, it is better to birth vaginally for the mother and baby. Babies born through c-section are more likely to have respiratory system problems. Delayed complications in children are also being studied, but the evidence has not yet been collected.
What are other reasons to consider c-section over vaginal birth:
- placenta previa;
- premature placental abruption;
- previous operations on the uterus (two or more c-sections, one C-sections and removal of fibroids, surgery for malformations of the uterus in history);
- incorrect presentation of the child;
- multiple pregnancy (with any wrong position of one of the fetuses);
- pregnancy over 41 weeks and no signs of labor;
- mother has a very narrow pelvis;
- deformities of the cervix and vagina (due to surgery or tumors);
- diseases of the mother, in which she can not push.
In all these cases, the c-sections will be planned in advance.
