How much do you know about a Cesarean section? Maybe you know someone who had the surgical procedure after complications during childbirth that required a baby to be delivered as soon as possible. Or perhaps, it was something planned in advance and thought to be the safest option due to a gynecological procedure done in the past. Whatever you do or don’t know about this form of delivery, one thing is certain: the numbers of C-section births occurring is increasing around the world. According to stats obtained by the CDC in 2019, in the U.S., 31.7 percent of all deliveries were Cesarean.
The month of April is known as International Cesarean Awareness Month. Organized by the non-profit International Cesarean Awareness Network. The point of the awareness month is to educate people so they know their options. One way to educate people is to help clear up misconceptions about C-sections. Some automatically believe that if you have one, all future pregnancies have to culminate in that same way. There is also a belief by others that a C-section is an “easy way out” because the vagina isn’t impacted during delivery. To set the record straight, we talked to Andrea Alexander, MD, FACOG, an OB-GYN based in Houston and author of Black Maternal Mortality: Our Fight Back. She filled us in on the reasons more people are having C-sections, when they’re recommended, and why they’re certainly not the “easy,” ideal route to take for expectant moms.
Complications vs. Convenience
According to Dr. Alexander, a major contributing factor to the increase in Cesareans worldwide is obesity. “Obese women have been noted in a plethora of studies to have prolonged labor courses, difficulties with anesthesia administration, larger fetal weights, and pregnancy-related illnesses,” she says. These types of factors often lead to an increased risk for a C-section.
But something else to consider, she noted, is that some doctors recommend the surgical procedure because it’s better for their schedule. Dr. Alexander says companies are expecting physicians to see more patients, and because of that, doctors may push for a C-section to hurry a delivery process along so they can get to the next patient. “Your doctor may see you’re not progressing as fast in labor and with years of experience under their belt, may call for a C-section pre-emptively to make ends meet with their schedules rather than waiting for the same result later when they are likely to be much busier,” she says. “This is why I listed some of the reasons for a C-section in my new e-book, to ensure we can all advocate for ourselves with the proper knowledge.”
Trial Labor After Cesarean Delivery Is Possible
As mentioned, some have been told that if you deliver via C-section one time, you will have to deliver that same way the next time you’re pregnant. That’s not necessarily true. There is a concern that if you attempt a vaginal birth after a Cesarean, the scar formed from your surgery could tear open during contractions. If that happens, Dr. Alexander says severe hemorrhaging and bleeding could occur, putting mother and child and risk.
“For these reasons, we recommend a trial of labor be performed after only one C-section, as the risk for the scar rupturing is <1%,” she says, mentioning the importance of attempting labor in a hospital with an obstetrician, fetal monitoring system, anesthesiologist and operating room readily available. “We typically recommend against a vaginal delivery if you have had more than one C-section and if your previous C-section was performed in a vertical manner on the uterus, as these factors lead to an even more increased risk in the scar rupturing.” Very few physicians would recommend trying for a vaginal delivery if you’ve had two C-sections or more.
Gynecological Procedures That Do and Don’t Lead to a C-Section
Just because one has had, for example, fibroids removed in the past, that doesn’t mean that when it’s time to deliver, the only way to do so successfully is via Cesarean. “Some things to question your surgeon about prior to discharge from the hospital is if your uterine cavity was entered, and if he or she recommends a C-section after said surgery,” Dr. Alexander says. “Remember, when the uterus contracts in labor, there is an increased risk of the scar opening and rupturing, especially if that scar is full-thickness, like that found in some myomectomies.” As for ovarian cysts, she does say it’s not entirely necessary for those who’ve had them removed to need a C-section as the ovaries are separate from the uterus.
The Surgical Procedure Is Anything but “Easy”
“Surgery is never the easy way out,” Dr. Alexander says. Cesareans are more complex than one incision in the stomach and then out comes the baby. Multiple layers have to be penetrated. “We must go through the skin, the subdermal fat, fascia, muscles, and peritoneum to get to the uterus.” That thorough process can lead to increased risks of bleeding, infection, damage to surrounding structures, complications, and poorer neonatal outcomes according to the doctor. In addition to that, the healing process is a lengthy one. “Your recovery time in the hospital will inevitably be longer after a C-section, which subsequently results in higher costs depending on your insurance coverage, and higher incidences of postpartum blues and depression,” she says. Also, the idea that labor pains are worse than postoperative surgical pain, is false. That can lead to medications that can impact your ability to breastfeed. And if you have a C-section once, your future pregnancies will be at a higher risk for complications.
C-Sections Aren’t Due to a “Failure” of a Woman’s Body
If you had a Cesarean, it’s not because you’ve failed your baby or yourself. Some feel this way after having to have surgery, but Dr. Alexander offers reassurance. “There is a reason the maternal and fetal death rates were higher during more primitive times. Women labored longer, which increased their risks of complications. C-sections were invented in part to decrease those risks. There was a reason for your surgery, and that was likely because it was to ensure your safety,” she says. “Regardless of ensuring one’s safety, it is still not an easy decision to make to consent to a C-section. The fact that you chose or are choosing the relatively ‘safer’ option to deliver your child means you already are proving to be an amazing mom. You chose your baby over yourself, and that in itself is the greatest form of love.”
Follow Andrea Alexander, MD on social media at @paging.dr.dre, and for more information on her and her book, Black Maternal Mortality: Our Fight Back, visit pagingdrdre.com.